Brunswick R-II School District Fitness Center Agreement Form
You may renew your access card to the Brunswick R-II School District Fitness Center by completing the form below.
Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
E-Mail Address *
Your answer
Gender *
Date of Birth *
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/
DD
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YYYY
Do you have a criminal record? *
Spouse Name (must be married)
Your answer
Spouse Gender
Spouse Date of Birth
MM
/
DD
/
YYYY
Children (ages 17 & under) living in my household. Please include gender and date of birth for each child.
Your answer
By initialing below I confirm that all the information given above is correct. *
Your answer
I have read, understand, and agree to abide by the terms of the Brunswick R-II School District's policy regarding the use of the Fitness Center/Weight Room facility. Should I commit any violation or in any way misuse my access to the District's Fitness Center/Weight Room, I understand and agree that my access privilege may be revoked and/or permanently suspended. *
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