Request edit access
Trojan Fitness Center Registration Form
Please fill out this form for the first member of the household registering. If you need to add other family members you will be directed to those pages. Thanks
Join Date
MM
/
DD
/
YYYY
Renewal Date
MM
/
DD
/
YYYY
Name *
Full Name
Your answer
Birthdate *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone # *
Your answer
Work Phone # *
Your answer
E-Mail Address
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone # *
Your answer
Payment Type *
I have read the following rules and regulations regarding the Trojan Fitness Center. By signing, I agree to the terms as part of my membership. I acknowledge my membership may be suspended or revoked if violations occur regarding said membership. http://goo.gl/TDmR6K (Policies Link) *
Type Full Name Below to Electronically Sign.
Your answer
Consult your physician before exercising at PCSD. Follow the exercises carefully and exercise at your own pace. If you feel any strain, stop and consult your physician. By my signature below, I acknowledge that I have read the foregoing, understand it, and agree to the terms. http://goo.gl/VqW2sP (waiver link) *
Type Full Name Below to Electronically Sign.
Your answer
PARENT’S OR GUARDIAN’S ADDITIONAL INDEMNIFICATION (Must be completed for participants under the age of 18) (No children under 14 years old may participate in using the equipment at the Trojan Fitness Center unless accompanied by a certified coach of Pleasantville Community Schools) In consideration of (“Minor”) being permitted to use the equipment at the Trojan Fitness Center. I further agree to indemnify and hold harmless the Pleasantville School District from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor. *
Type Student's Name(s) that is Minor and Parent/Guardian Name to Electronically Sign
Your answer
Type of Membership *
If you are selecting a membership with more than one person you must complete a registration form for each person.
Next
Never submit passwords through Google Forms.
This form was created inside of Pleasantville Community Schools. Report Abuse - Terms of Service - Additional Terms