Covenant Presbyterian Church
Recreation & Fitness Center
Registration Form
Church Memberships
* Optional Drop-In Fee $1 per visit
* Student $25 year
* Senior Adults (55+) $25 year
* Individual (ages 12-54) $50 year
* Household Individuals residing at same address $75 year
Non-Church Memberships
* Permanent Guest $3 per visit
* Student $180 year - $15 monthly
* Senior Adults (55+) $180 year - $15 monthly
* Individual (ages 12-54) $240 year - $20 monthly
* Household Individuals residing at same address $360 year - $30 monthly
PAYMENT PROCESS
1) Pay for a 12-month membership in full at time of registration by cash or check.
2) Participate in the monthly auto-draft. Additional paper work is required.
3) If joining for less than a 12-month period, we can pro-rate.
REGISTRATION FORMS
Available at the front desk and on-line. A separate registration form is needed for each person in your household 6th grade or older who will be using the facility. Completed forms can be mailed in with payment or brought to the Recreation and Fitness Center desk any time during regular operating hours. Please make checks payable to Covenant Presbyterian Church.
GUEST POLICY
Guests may accompany a Recreation and Fitness Center member three times at no cost, but are required to obtain a guest pass from the desk attendant. After three visits guests will be required to pay $3.00 for each additional visit OR become an affiliate member of the Recreation and Fitness Center. Center members may only bring up to three guests per visit.
AGE POLICY
Children under 12 MUST be supervised by an adult (age 18 +), except when attending a program where supervision is provided. For liability reasons, no one under 16 may occupy the track or weight room, unless authorized by the Director.
REGULAR HOURS (see changes below effective during youth basketball season)
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Monday - Thursday 6:00 am – 9:30 pm
Friday 6:00 am – 3:00 pm
Saturday 9:00 am – 2:00 pm
Sunday 1:00 pm – 7:00 pm
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DURING BASKETBALL SEASON: November – first week of March (practices begin & end)
Friday’s change to: 6 am – 7 pm
DURING BASKETBALL SEASON: December – first weekend of March (games begin & end)
Saturday’s change to: 8:00 am – 4:30 pm
OTHER RULES AND POLICIES
A. No profanity.
B. Sign in or scan card at front desk before using the facility.
C. Non-marking shoes are required on the gym floor; street shoes are not allowed.
D. Alcohol, tobacco, controlled substances & anything considered a weapon is prohibited in the facility.
E. Food and drink are not allowed on the gym floor, track or weight room at any time.
F. No one under 16 may occupy the track or weight room, unless authorized by the Director.
G. Rollerblades are allowed during skating times provided wheels are free of dirt.
H. Pets are not allowed inside the building.
I. Clothing that is appropriate for the activity and properly covers body parts should be worn.
J. Strollers are not allowed on the track.
K. No hanging on basketball rims, pulling on nets, or smacking the backboards.
L. Discipline problems will result in several levels of infraction: including warning, reminder, and notification of parents if under 18 years of age, and possible suspension of use.
M. Violation of any rules or regulations could lead to suspension of user privileges or loss of eligibility to participate. Serious discipline problems will be dealt with by the Director and the Recreation Ministries Committee. Covenant Presbyterian Church reserves the right to revoke a membership at any time without reimbursement.
O. Lost ID scan cards cost $3 to replace.
Visit our webpage at www.covenantpresby.org under “Connect” or go to: Covenant Recreation on Facebook for up-to-date information.
James Huffman, Recreation Ministries Director
704-334-7491
COVENANT PRESBYTERIAN CHURCH
Recreation and Fitness Center Registration Form
A) Church Membership
[ ] Optional Drop-In Fee: $1 per visit
[ ] Student: $25 year
[ ] Senior Adult (ages 55+): $25 year
[ ] Individual (ages 12-54): $50 year
[ ] Household: Individuals residing at same address $75 year
B) Non Church Membership (Non-Church member)
[ ] I am an affiliate member
[ ] Student: $180 year - $15 monthly
[ ] Senior Adult (ages 55+): $180 year - $15 monthly
[ ] Individual (ages 12-54): $240 year - $20 monthly
[ ] Household Individuals residing at same address: $360 year - $30 monthly
[ ] I am a permanent guest
[ ] Permanent Guest: $3 per visit
PLEASE PRINT CLEARLY
1] Name 1: ______Cell ______DOB ______
Name 2 ______Cell ______DOB ______
Name 3 ______Cell ______DOB ______
Name 4 ______Cell ______DOB ______
Name 5 ______Cell ______DOB ______
2] Address: ______
City: ______State: ____ Zip: ______Main Phone: ______
3] E-mail address: ______
Email address #2: ______
4] In case of emergency: Name: ______Phone: ______
Name: ______Phone: ______
5] Family Physician: ______Phone: ______
6] Medical problems / concerns: ______
Waiver Statement:
I, the undersigned registrant, or parent/guardian of registrant for use of the Recreation & Fitness Center, Covenant Presbyterian Church, Charlotte, NC, do hearby release and discharge Covenant Presbyterian Church and its authorized representatives, volunteers and staff from all liability of any kind and character upon any claim, demand or course of action which might be asserted on behalf of myself, any children under 6th grade or any guest against the church, representatives, volunteers or staff. Furthermore, in case of an accident or medical emergency, if the staff or representatives are unable to contact the parent(s)/guardian(s), I hearby grant permission to the staff or representatives to administer necessary first aid, and/or to arrange transportation to the nearest medical facility or treatment.
I understand that before beginning any exercise program, I should consult with a physician. In addition, if I am on a medically supervised exercise program, I will clear my use of the Recreation & Fitness Center with my supervisor. I agree to obey all the policies and procedures of the Recreation & Fitness Center; to keep the facility clean and to promote a Christian atmosphere.
______
Signature of registrant Date of registration
______
Signature of parent/guardian (if registrant is 18 years old or younger)
This Section for Staff1) Have registration form(s) been completed & signed? [ ] Yes [ ] No
2) Has annual fee been collected? [ ] Yes [ ] No
3) If an Affiliate & participating in auto-draft has paperwork been turned in? [ ] Yes [ ] No
4) If a Permanent Guest has $3 been collected? [ ] Yes [ ] No
5) Check appropriate box
Membership Status
Church Members / Annual Fee
[ ] Optional Drop-In Fee / $1 per visit
[ ] Student / $25 year
[ ] Senior Adults (55+) / $25 year
[ ] Individual (ages 12-54) / $50 year
[ ] Household / $75 year
Affiliate Members / Annual Fee / Mo. Draft / Pro-rated
(If joining after January)
[ ] Permanent Guest / $3 per visit
[ ] Student / $180 / $15 _____
[ ] Senior Adult (55+) / $180 / $15 _____
[ ] Individual (12-54) / $240 / $20 _____
[ ] Household / $360 / $30 _____
6) Cash or Check # ______Amount Paid ______Date ______
7) Membership start date______Membership end date ______
8) Referring to page 3, does this person need an ID scan card? [ ] Yes [ ] No
9) Picture made ______Card made______Card issued______
10) Forms & fees turned into Assistant/Director & added to tracking sheet
Signature ______Date ______
11) Form processed by Admin.______Date______
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