Health Fitness & Wellness Release Form

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Health Fitness & Wellness Release Form for Lehigh Carbon Community College

Berrier Hall (Fitness Center, BH 1)
4525 Education Park Drive
Schnecksville, PA 18078
610-799-1181

Last Updated: 11/22/21

First Name *

Last Name *

L Number *

By filling out the following form, you are electronically agreeing to the terms and conditions of the Fitness/Wellness Center at Lehigh Carbon Community College. Entry to the Fitness/Wellness Center is permitted once the following form is completed and a valid LCCC ID is presented to a staff member at the Fitness/Wellness Center in Berrier Hall. This form only needs to be filled out once, unless changes are made at the beginning of each semester, in which users of the Fitness/Wellness Center will be notified. Fitness/Wellness Center use will be granted as long as the participant presents their LCCC ID to a staff member upon entry to Fitness/Wellness Center and has successfully completed the following form. Remember- NO ID, NO ENTRY!

Do you agree to the terms and conditions as explained above? *

Yes

If you are under the age of 18, you will need a parent or guardian sign a paper copy of this form. *

I am over the age of 18.

I am under the age of 18, I agree to get a parent or guardian to sign a paper version of this form before using the Wellness Center.

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