Form Center

2. Summit on the Park Fitness Orientation
   All young adults between the ages of 12-17 must attend a fitness center orientation and provide a completed/signed waive or liability prior to using the fitness center.
4. Participant Last Name*
6. Participant First Name*
8. Participant Date of Birth*
   ex. 1/1/2002
10. Street Address*
12. City*
14. State*
16. Zip Code*
18. Emergency Contact Information
20. Last Name*
22. First Name*
24. Relationship to Participant*
26. Phone Number*
    Enter Format - XXX-XXX-XXXX
28. Participation Agreement *

    I hereby state that the participant listed above is in good health and understands the potential physical risks involved with using strength equipment and cardiovascular equipment. Participant also understands that no horseplay or inappropriate behavior will be tolerated in the fitness center and such behavior may result in suspension from the Summit in accordance with the Leisure Services Code of Conduct.

    1. Yes
    2. No
30. Students Between Ages 12-13
    If my child is between the ages of 12-13, I understand that they can participate in the fitness center of a fitness class with myself, or another parent/guardian. I also understand that I or another parent/guardian must also keep the child under direct supervision, on the same piece of equipment or right next to them, while in the fitness center
32. Parent/Guardian Initial if child is between ages 12-13 years of age
34. Waiver of Liability
    In consideration for the foregoing, I for myself, my child, my family, executors, administrators, and assignees, do hereby release and hold harmless the Charter Township of Canton, their employees, volunteers, and board members, all sponsors, coordination groups, individuals and all parties associated with the activity, for any and all claims, demands, and damages, including bodily injury of death, and all actions whatsoever that arise out of my of my child's participation in said event.
36. Parent/Guardian Signature*
    Please type full name
38. Date*
    Please enter format 1/1/2001
40. Participant Initials *
    I have been instructed on how to safely use fitness equipment within the Fitness Center and understand the Fitness Center rules, guidelines, and general safety information.
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field