Name *

Complete form for each person that will be visiting.

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

RELEASE OF LIABILITY AND ASSUMPTION OF RISK *

City of Germantown will not assume responsibilities for any injury incurred while participating in any athletic event, sports program or any physically related activity. Nor will City of Germantown be liable for any lost or stolen items while program participants are using Club facilities or on Club premises. I, the undersigned for myself, my heirs and assigns, do hereby release City of Germantown, its employees and agents from and all claims for injury, death, loss or damage I may suffer as a result of my participation. Guest represents and warrants City of Germantown that the guest is in good physical condition and has no medical reason impairment that could prevent the guest from his/her use of City of Germantown facility.

I agree.

Guest Signature *

First Name

Last Name

Date *

MM

DD

YYYY

What programs and amenities are you most interested in? *

Check all that apply.

Indoor pool

Cardio equipment

Strength equipment and free weights

Indoor walking track

Group exercise classes

Personal training

Swim lessons

Child care

Raquetball

Basketball

How did you hear about us? *

Check all that apply.

Friends/family

Social Media

Internet search

Direct mail

Event

Other

What date would you like to start your pass? *

The 3 days are consecutive. Please choose a start date in which you will be using your pass.

MM

DD

YYYY