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RPCC Fitness Room Membership Enrollment Form

  1. JCPRD logo

  2. Membership Type

  3. Is this a referral?

  4. Membership Information

  5. Residency*

  6. Membership Length*

  7. Membership Type*

  8. Electronic Signature Agreement

    (1) As a member it is my desire to use the facilities of the Roeland Park Community Center of Johnson County Park & Recreation District. I understand the Roeland Park Community Center (RPCC) is willing to allow me to use the facilities, subject however, to my agreement with and execution of this Membership Waiver. By executing in the space provided below, I certify that I have read, understand and agree to all terms and conditions of this Membership Waiver. (2.) I understand that participation in weight training, and other physical activities at RPCC involves risk to myself. Special protective or supportive gear may be advisable depending on my personal health situation, of which RPCC has no knowledge. I accept full responsibility for making sure that I have all the necessary equipment in order to afford me the protection that I may need in order to participate in any of the activities in which I will be engaged while at RPCC, and that I have no physical infirmities, weaknesses or impairments which would prevent me from participating in RPCC activities safely and without injury. (3.) I understand that it is recommended to consult my physician prior to starting a new exercise regimen. (4.) I understand and agree that neither the Johnson County Park and Recreation District and the Roeland Park Community Center nor its employees or contractors are responsible for damage to, loss or theft of my personal property while on RPCC premises, and further, that RPCC is not responsible for the acts of other guests or members. (5.) I have read and agree to abide by the rules of RPCC during my visit, and I agree to pay the cost of any damage I may cause to property or persons while on RPCC property. RPCC reserves the right to terminate my contract if I do not follow facility rules. (6.) It is my intention to release and forever discharge the Johnson County Park & Recreation District and the Roeland Park Community Center, its employees and contractors form any and all cost, damage, liability or claim that I may have, whether now or in the future, and I agree to assume all risk of injury or damage that I may suffer while on RPCC premises. I further agree to indemnify and pay RPCC for any expenses or damage it might suffer as a result of my presence on RPCC premises or my actions while there. (7.) I authorize the Johnson County Park & Recreation District and the Roeland Park Community Center to use at its discretion any photograph(s) taken of me while participating at RPCC, and also give permission for the free use of my name and picture in any broadcast, telecast, or print media account of RPCC activities. (8.) If the member is a minor - I, as the undersigned parent or guardian, hereby agree to all the terms stated above in regard to the minor’s participation, and accept full responsibility for the actions and outcomes of the minor’s participation. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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