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2020 Social Club Membership Form

  • CONTACT INFORMATION

  • Legal Name * Required
  • If you prefer to be called something other than your legal name place name here.
  • Address * Required
  • HEALTH INFORMATION

  • Date Format: MM slash DD slash YYYY
  • Please state any medications, allergies or injuries we should be aware of. If none place NA
  • EMERGENCY CONTACT INFORMATION

  • Name * Required
  • Waiver of Liability, Assumption of Risk, and Indemnity Agreement

  • Participation Waiver: In consideration of the opportunity to participate in any of the activities ("Activities"), provided by the City of Madeira Beach, I, for myself, my family, my children, my heirs, my estate, my personal representatives and assigns (hereinafter collectively referred to as "Participant:), do hereby completely and fully release, waive, covenant not to sue, and forever discharge the City of Madeira Beach, its elected and appointed officials, and its officers, employees and agents (collectively hereinafter "the City"), from all liability, responsibility, actions, damage, costs and claims for personal injury, accidents, illnesses, death, and property damage and loss (hereinafter collectively referred to as "Injuries and Loss"), arising from, related to, or in any way connected to participation in any of the Activities.
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