2025 Membership Enrollment

Membership Sign Up and Renewal Form

Fill out the form below to sign upNew Member orRenewal Member
Name

First NameLast Name
Date of Birth

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Date
Address
City
State
Zip Code
County
Email
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Cell Phone Number
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Home Phone Number
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Spouse Name
Aniversary Date

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Date
Emergency Contact Name
Emergency Relation
Emergency Phone Number
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Email
example@example.com
Yes
WAIVER AND RELEASE OF LIABILITY: I understand that the activities, services, trips and events offered by the Parker Senior Center

possibly may have an element or hazard or inherent danger and further may be an extreme test of a person's physical and mental abilities. I understand that my participation in such activities, services, trips, and events can cause serious injury, potential death and property damage. Ifurther understand participating in activities and trips while in a wheelchair may present special hazards, inherent danger and be an extreme test of physical abilities. With full understanding of the potential risks, I hereby assume the risks of participating in activities, services, trips and events offered by the PSC. On behalf of myself, my executors, administrators, heirs, next of kin, successors and assigns, I hereby waive, release and discharge the PSC, its officers, directors, employees, and volunteers from any and all claims, liabilities, losses, costs, or expenses, for death, personal injury, or damages of any kind that I may incur while participating in or traveling to and from PSC on-site or off-site activities, services, trips and events, whether such losses, damages or injuries are a result of negligence of PSC, its officers, directors, employees, and volunteers except for loss, damage, or injury which is the result of gross negligence and/or wonton misconduct of PSC, its officers, directors, employees and volunteers. I agree to indemnify and hold harmless PSC, its directors, employees and volunteers from any claims made or liabilities assessed against them as a result of my actions, or any action taken on my behalf.

In consideration of the rights and privileges granted to me by my involvement with the PSC, I certify that I have read and understand the above WAIVER AND RELEASE OF LIABILITY and that I understand that I have given up substantial rights by signing this document, and hereby acknowledge that I am signing voluntarily. I also understand and agree that my photograph may be taken while participating in PSC activities, services, trips and events and such photograph may be used in publications and for promotional purposes and I will not be compensated for the use of my photographs. As a member of the Parker Senior Center, I will adhere to the "Code of Conduct" as set forth in the Bylaws.
I agree to theWaiver and Release of Liability
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Date

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Date
Annual Member Cost (per person) $100*
Parker Senior Center Where active seniors meet

See the activities listed in the monthly Newsletter for current month activities, their timing and travel options. Most activities are walk-in and free, exceptions, travel and food event charges are noted. New member orientation is the last Thursday of each month at 9am at the Center. Veteran Status - for grant purposes only, please add the following:
Branch
and Service Dates

MonthDayYear
Date
Branch
and Service Dates

MonthDayYear
Date
Getting Involved with your PSC Friends, Board, Staff and Volunteers

One of the ways to get the most out of your membership at the Parker Senior Center is to get involved with volunteering. You will make friends, improve the community, get to know the staff and other members and have a voice in the workings of your Senior Center. Volunteer Opportunities: [Please check off your preferences]

Activity Chairs/Advisors Working with Business Partners Sports Proofreading Newsletter or mailings

Fundraising / Donation Caller Membership / Outreach

Travel Trip Driver (Using Center bus or van) Organize speakers and Center educational programs

Kitchen Help (Weekday Lunches, Potlucks & Special Events0

Set up for Programs (Tables and Chairs, Podium)
Special EventsConnect and Care CallerActivity Chairs/AdvisorsWorking with Business PartnersSportsProofreading Newsletter or MailingsKitchen HelpSet Up for Programs (Tables and Chairs, Podium)Front Desk/GreeterFund Raising /Donation CallerMembership OutreachCommittee WorkTravel Trip DriverOrganize speakers and Center Center Center educational programsOther
Occupation previous or ongoing
Hobbies or other interest
Favorite Restaurants
Parker Senior Center 10675 Longs Way Parker, CO 80138 (303) 841-5370 © 6/2025

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