Link Charter Membership Agreement

Link Charter Membership Agreement

An individual membership is only valid for the one person that it is listed below. Family memberships are only valid for a parent or parenting couple, who reside at the same location, and all of their legal dependents. Paid in full memberships cannot be terminated early unless member is moving or unfortunately expires prematurely.

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First Name(s) Last Name Birth Date

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Street Address City Zip

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Home Phone Cell Phone Provider (for Text Updates)

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Email Bag or Tote

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Emergency Contact First Name(s) Last Name Phone Number

Family Information (please fill out for anyone in the household who might attend programs)

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Spouse/ Partner First Name(s) Last Name Birth Date

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Dependent 1 First Name(s) Last Name Relationship

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Gender Birth Date

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Dependent 2 First Name(s) Last Name Relationship

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Gender Birth Date

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Dependent 3 First Name(s) Last Name Relationship

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Gender Birth Date

FOR STAFF TO COMPLETE

Res or Non-Res Individual or Family Discounts? ______Rate $______Initial ______

Waiver and Photo Agreement

In exchange for me and my dependents’ (listed above) right to use any Link equipment, or participate in any activity located at or sponsored by the Link, I hereby agree to assume and all risks attendant to any such use or activity, whether occurring on public or private property, which might affect me in any manner whatsoever, and hereby hold harmless, indemnify and release the City of Richland Hills (the “City”), its officers, and employees, in both their public and private capacities, from all liability for any harm, bodily injury or property damage that may occur to me or my dependents (listed above), and waive, on behalf of myself, my heirs and my estate, and any dependents (listed above), and claims or causes of action against the City, its officers and employees arising from my use of Link equipment or my participation in any activity located at or sponsored by the Link, including damages, liability, claims, suits, demands or causes of action which arise from the negligent act or omissions of the City, its officers, agents, or employees.

I agree that the execution of this release shall not constitute a waiver by the City of the defense of governmental immunity, where applicable, or any other defense recognized by the courts of Texas. I certify that I have read the foregoing instrument, that I understand its terms and conditions, that I make this release and waiver voluntarily, and that I have not relied upon any representation make by the City, or its offices, agents, or employees in signing this release.

Further, I hereby grant permission to the City, to take and/or use photographs, digital images and/or videotaped scenes to use, reuse, publish, and republish these images and this information in whole and/or in part, individually or in connection with other material, in any and all media now and hereafter known, including the internet, and for any purpose whatsoever, without restriction as to alteration; and to use my or my dependents’ name in connection with any use if the City so chooses. I RELEASE AND DISCHARGE THE CITY FROM ANY AND ALL CLAIMS AND DEMANDS THAT MAY ARISE OUT OF OR IN CONNECTION WITH THE USE OF THESE IMAGES, INCLUDING WITHOUT LIMITATION ANY AND ALL CLAIMS FOR LIBEL OR VIOLATION OF ANY RIGHT OF PUBLICITY OR PRIVACY. I authorize the use of these images without compensation to me. All negatives, prints, and digital reproductions shall be the property of the City.

AGREED on this ______day of ______, 20___ in Richland Hills, Texas

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(Guardian) Signature Print Name Date

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Spouse if Applicable Print Name Date

Covers the following dependents: ______

Print Minor’s Names, Adult Dependents need Signature

For Monthly Drafts

Please attach a voided check for or fill out the information before for monthly membership drafts. Drafts are scheduled on the 15th, but depending on the banks holidays and business days, the funds must be available up to five days after the schedule draft date. If the draft does not go through, your account will be charged a $10 fee, plus any additional charges the City of Richland Hills incurs due to failed draft. By signing below, you authorize the City of Richland Hills to draft monthly from your account the amount commiserate to the membership that you chose ($______). This draft will take place 11 times unless I give 30 days notice for cancelation. During the 30 days of notice, I understand that the usual amount will be drafted from my account.

Card Type ______Card Number ______

Name on Card ______Exp Date ______CSV______

I authorize a draft from checking account or credit card monthly. ______