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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 fitness room of Johnson County Park & Recreation District at the Roeland Park Community Center. I understand the Roeland Park Community Center (RPCC) is willing to allow me to use the fitness room, 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 in the RPCC Fitness Room involves risk to myself. Special protective or supportive gear may be advisable depending on my personal health situation, of which JCPRD 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 the RPCC Fitness Room, and that I have no physical infirmities, weaknesses or impairments which would prevent me from participating in RPCC Fitness Room 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 Johnson County Park & Recreation District is not and shall not be responsible for or liable for any illness, injury, or death to person or damage to property, including but not limited to illness, injury, or death arising from exposure to the Novel Coronavirus (COVID-19), resulting from the program/activity in which the undersigned is enrolling or being enrolled or from his/her participating in said program/activity, and the participant and the undersigned, if the participant is a minor or under other legal disability, hereby forever releases and holds harmless the said Johnson County Park & Recreation District, it's employees, agents and representatives from any and all claims of any kind, including but not limited to claims arising from exposure to the Novel Coronavirus (COVID-19), that the participant, or the undersigned or their respective heirs, executors, administrators, or assigns may have or claim to have resulting from participation in said program. NOTICE: By enrolling in this program/activity you hereby acknowledge the Johnson County Park & Recreation District can and may photograph and/or video tape program participants and then use such images without payment or any other consideration, for purposes of publicizing District parks, facilities, programs or services, or for any other lawful purpose. (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.) 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.
  9. Leave This Blank:

  10. This field is not part of the form submission.