UW Hillel Fitness Center Membership

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Student ID Number*

You must be a student to use the Hillel Fitness Center

Please select your graduation year*

Email*

Campus Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Family Contact?*

First NameLast Name

Emergency Contact Email

example@example.com

Emergency Contact Phone Number*

Area CodePhone Number

UW Madison Hillel – Fitness Center WAIVER AND RELEASEOF LIABILITY - The UW-Madison Hillel Fitness Center (“Fitness Center”) is an unsupervised recreational area that includes a shower facility that exists for the sole benefit and use of the staff and users of the UW-Madison Hillel: The Barbara Hochberg Center for Jewish Life (“Hillel”). The undersigned (“I”) hereby acknowledges and agrees that using exercise equipment and engaging in physical activity is a potentially hazardous activity. I certify that I am able to engage in strenuous exercise and that I know how to properly use the equipment provided. I understand that I could suffer a serious or fatal injury while using the Fitness Center. I assume any and all risks of using the Fitness Center, including without limitation the showers and any facilities and equipment. I hereby acknowledge and agree that Hillel does not assume responsibility for maintaining the equipment in the Fitness Center, training employees or contractors in the use of such equipment or assuming any legal risks or liabilities whatsoever in making such equipment available. I agree to promptly report to the Hillel staff in writing, any exercise equipment which I believe may be unsafe or present an unreasonable risk of injury to any users of such equipment. Having read this waiver and knowing these facts and in consideration of Hillel allowing me to use the Fitness Center, I for myself and anyone entitled to act on my behalf, hereby waive and release Hillel, its officers, directors, employees, contractors and representatives, and successors from all claims and liabilities of any kind arising out of my use of the Fitness Center even though that liability may arise out of negligence or carelessness on the part of Hillel or its, officers, directors, employees, contractors or representatives. I further agree that I will not offer or grant access to the Fitness Center to any other person not authorized for such access by Hillel. I agree to abide by all posted rules and guidelines and I understand that permission to use the Fitness Center may be revoked without refund at any time by Hillel’s management for good cause. Please type name below*

Type Name Here

Fitness Center Rules - Please Respect this space and your fellow students - 1) Do not drop free weights or weights on the Universal Machines. 2) Return all weights, straps. handles, etc. to their proper place, not lying on the floor. 3) Wipe down equipment after use. 4) Be respectful to others, personal music should be played through earbuds. *

Type Name Here

Membership Options*

Spring semester membership

$125.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration