rac Membership form

your ultimate experience membership includes access during public hours to the pool, ice rink, gymnasium, fitness center, and fitness classes. It also gives you discounts on birthday parties, reservations, and more.

*Family members must be listed on the same tax return as the primary member

Membership Type

Primary Guardian's Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

RAC Swimmer Name

Include first and last name of your swimmer.

First Name

Last Name

RAC Swimmer Birth Date

Include birth date of RAC swimmer.

YYYY

RAC Swimmer Gender

RAC Swimmer Name #2 (if necessary)

If you have two swimmers, this is where you can put your other child's first and last name.

First Name

Last Name

RAC Swimmer Birth Date #2 (if necessary)

If you have two swimmers, this is where you can put your other child's birth date.

YYYY

Gender RAC Swimmer #2 (if necessary)

Guardian's Employer

Location of Employer

Emergency Contact Name

First Name

Last Name

Emergency Contact Relationship

Emergency Contact Phone Number

(###)

###

####

Demographic Information

We are committed to serving families from all walks of life. You providing the information below allows grant opportunities that support our high-quality programming and your overall experience.

Total Annual Household Income (include: Social Security, Child Support, Alimony, Pensions)

Terms of Membership

-I understand that members may be photographed for the possibility of being used for publicity and I give exclusive rights to these photos to the Jones Center and waive all claims for compensation for usage. -There is a non-refundable $15 yearly admin fee for all monthly and yearly memberships. -All memberships are non-refundable. -You may cancel (non-refundable) membership anytime with a written notice by the 10th of each month. -A child must be 13 or older for fitness center use and 16 or older for use without parental supervision.

Waiver Agreement

I understand that the use of facilities and equipment at The Jones Center may involve risk of property damage or bodily injury including, but not limited to, broken limbs, paralysis, concussions, drowning, or even death and in consideration to my and family members use of the facility I, my heirs, representatives, executors, administrators, and assigns HEREBY DO RELEASE, INDEMNIFY, AND HOLD HARMLESS The Jones Center, its directors, employees, volunteers and participants from any course of action, claims, or demands including, but not limited to, negligence, personal injury, property damage, death, or an accident of any kind, arising out of or in any relation to the use of The Jones Center facilities. I acknowledge that my use of The Jones Center is completely voluntary, and I assuming all risk that comes with using the facility because I have read this agreement in its entirety.

How would you like to pay?

If planning to pay monthly, please answer the following questions

Authorization Agreement Automatic Payments

I hereby authorize The Jones Center to initiate debit entries and to initiate, if necessary, credit entries and adjustments for any debit entries in error to my (our) account indicated below and the financial institution named below, to credit and/or debit the same to such account. Any change or cancellation to this draft must be provided by the 10th of the month in written notice by either party. Should my membership draft not be honored by my bank for any reason, I realize that I am still responsible for that payment.

Membership Expiration Date

Membership Expiration Date: If undecided, your membership will automatically renew each month until written notice before the 10th of the month. Type Membership Expiration Date that you desire.

YYYY

member benefits

No long-term agreement
Free assessment with personal trainer
Use of locker rooms and showers
Free public Wi-Fi
20% off room reservations
20% off birthday parties
20% off activities
Outdoor Walking Trail
Community Park

Questions about our new membership pricing? See our FAQ page or contact our membership team for more details.

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