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Registration: Utilities Fitness Center
(Apr 3, 2018 08:00 am - Dec 31, 2020 11:59 pm)


 Please read the Liability Waiver Terms & Conditions prior to completing this form. 
 
Open to BCC Employees and their adult covered dependents only!
 

USER INFORMATION

First Name:
Last Name:
Date of Birth:
Employee Status:
Employee  Spouse  Dependent  
Phone:
Phone Type:
Cell  Home  Work  
Email:
Confirm Email:
Emergency Contact Name:
Emergency Contact Phone #:
Emergency Contact Relationship (friend, spouse, etc.):
I acknowledge that I have read this document and understand this agreement, and I realize it relates to surrendering and releasing valuable legal rights and do so freely and voluntarily.:
Yes
I understand that the Fitness Center hours are M-F 5am-9pm & Sat/Sun 7am-7pm, and that during the busiest times of 10am-1pm and 3pm-5pm, equipment availability may be limited.:
Yes
I understand that I am required to park in the shell parking lot, south of the fitness center building, during business hours ( 7a-4p).:
Yes
Participant Signature (typed name is considered an electronic signature):

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Our team will be glad to help you anytime with general
or technical questions, suggestions or comments.