Preview Gym Membership Registration Form

Apex Parks, Recreation and Cultural Resources

Open Gym Registration Form

Applications are processed at the Apex Community Center

Mon-Fri 8:00am-9:00pm - Saturday 9:00am-6:00pm - Sunday 1:00pm-6:00pm

The Community Center is closed on Sundays during the months of June-August

53 Hunter Street, Apex, NC 27502 - (919) 249-3402 - [email protected]

www.apexnc.org/services/parks-recreation-cultural-resources/open-gym

Applicant Name ____________________________________

Or parent if parcipant is under the age of 18 years

Address____________________________________________

Primary Phone_______________________________________

Email Address _______________________________________

Emergency Contact___________________________________

Other than parent of minors

Date of Birth ________________________________________

City_______________State__________Zipcode____________

Addional Phone____________________________________

Addional Email _____________________________________

Phone _____________________________________________

For Sta Use:

R____ NR____ Sta:________

Receipt #: ____________________

Fees (for ten visits):

Resident Age 0-7 Free

Resident Age 8-17 $5

Resident Age 18-54 $10

Resident Age 55 & Over Free

Non-Resident Age 0-7 $5

Non-Resident Age 8-17 $20

Non-Resident Age 18-54 $30

Non-Resident Age 55& Over $20

 Open Gym membership fees are based on Resident status which are dened as individuals that reside within the established corpo-

rate limits of the Town, as dened by the Planning Department. (see hp://les.www.apexnc.org/docs/plan/apexstreets.pdf)

 Open gym memberships do not expire and are non transferable. Do not risk losing your membership by allowing others to use your

card.

 Children age 9 and under MUST BE ACCOMPANIED BY AN ADULT (18 YEARS OF AGE OR OLDER) AT ALL TIMES.

 Parcipants MUST CHECK IN AND SHOW THEIR MEMBERSHIP CARD EACH VISIT. Failure to present the open gym card 2 mes will

result in a $5 fee on the third visit - NO EXCEPTIONS!!!

 Guests may visit open gym with members for a fee of $5. Members may check in only a maximum of three guests per visit.

 Personal sports equipment is not allowed in the facility.

 Appropriate athlec shoes and clothing must be worn at all mes.

 Absolutely NO FOOD, GUM or DRINKS permied in gymnasiums.

 Absolutely NO DUNKING or HANGING ON THE RIM. Repeat oenses could result in suspension or permanent loss of privileges.

 Horseplay, ghng, oensive language, and/or destrucon of Town property are prohibited at all mes.

 Disrupve behavior will not be tolerated. Parents/Guardians will be contacted if there are problems. Repeated instances of problem

behavior could result in the suspension or permanent loss of membership privileges.

 Personal items brought into the facility may be stored in the restroom lockers BUT MUST NOT REMAIN OVERNIGHT. Any locks will be

cut from lockers at close of business day and items will be put in the lost and found collecon. Lost and found items are donated

aer a 30 day period of me.

 The Town of Apex is not responsible for any lost or stolen property.

 The Open Gym schedule is SUBJECT TO CHANGE WITHOUT NOTICE and changes month to month. Calendars are available in the

Community Center lobby or you may check online at www.apexnc.org.

 The APR&CR reserves the right to photograph parcipants for publicity purposes.

Statement of Waiver: I, for myself or as a parent or guardian hereby assume all risk and hazard incidental to the conduct of this acvity. I release, absolve and indemnify the

Town of Apex, employees of the Town, volunteers, contractor and sponsors from all risk and hazard associated with this acvity. In the event of injury, do expressly waive

all claims to the Town of Apex. I understand no insurance coverage is provided by the Town of Apex or the Parks, Recreaon and Cultural Resources Department. I further

give permission for proper emergency care to be rendered to myself or child should I not be able to give such permission.

Applicant Signature ________________________________________________________________________ Date:__________________

(Parent or Guardian if under 18 years of Age)

NAME DATE OF BIRTH NAME DATE OF BIRTH

List Additional Applicants for Open Gym Passes within the same household

HTML Preview Gym Membership Registration Form page number 1.