Guest Name *

First Name

Last Name

Guest Birthdate *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you under 18 years of age? *

Guests under 18 must have a guest visit waiver completed and signed by, or submitted online by their parent or legal guardian.

Yes

No

Emergency Contact Name *

If under 18, Emergency Contact must be a parent or legal guardian.

First Name

Last Name

Emergency Contacts Phone *

(###)

###

####

Have you been to The Club before? *

Yes

No

How did you hear about The Club? *

Direct Mail

Drive By

Internet

Newspaper

Been Before

Referred By / Guest of Member

Other

Interests

Nutrition

Spa

HE Parks Programs

Group Fitness

Weight Training

Basketball

Pickleball

Personal Training

Cardio

Swimming

Waiver Acknowledgement *

Please read the following carefully and be aware that in signing up and participating in the Hoffman Estates Park District identified programs/activities, you will be expressly assuming the risk and liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services/vehicle operation, when provided). I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any injuries, damages or loss regardless of severity, that I or my minor child/ward may sustain as a result of participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in these programs/activities against the Hoffman Estates Park District, including its officials, agents, volunteers and employees (hereinafter collectively referred as Hoffman Estates Park District). I do hereby fully release and forever discharge the Hoffman Estates Park District from any and all claims for injuries, damages or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with or in any way associated with these programs/activities. I agree to follow all Guest and/or Family Rules & Regulations, as well as Member Guidelines.

I have read the above guest waiver and I agree to follow all Guest and/or Family Rules & regulations, State, County and Federal Mandates, as well as Member Guidelines.