CENTRAL CITY CONVENTION CENTER

  • CENTRAL CITY CONVENTION CENTER

  • USER APPLICATION

  • User Application for Primary User

  • A primary user shall consist of an adult (age 18 or older) who is responsible for the payment of the monthly fees (as determined by the user fee payment level at which he/she elects to participate). The primary user is responsible for any additional family members included within this agreement. You must provide front desk with a valid driver's license to be photocopied.
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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • ADDITIONAL FAMILY MEMBERS (SPOUSE AND DEPENDENT CHILDREN ONLY, NO EXCEPTIONS) (*$10 additional fee per person, per month for families with more than 6 members)
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  • Please select the type of user fee plan you are enrolling for:

  • CENTRAL CITY CONVENTION CENTER

  • USER AGREEMENT

  • I, ______________________________________________________, hereby make application for status as an ongoing user at the Central City Convention Center. I acknowledge having received a copy of the facility handbook which contains policies and procedures and I agree to abide by the same. I understand that by signing this contract, I am liable for a full year of membership. I understand that to terminate my contract, I must provide proof of address change of more than 25 miles from the facility and/or a doctor's statement proving I am unable to engage in physical activity. I agree to pay the monthly user fees based on the agreed terms below.
  • USER FEE PAYMENT PLAN (Please initial the appropriate payment plan)

  • CENTRAL CITY CONVENTION CENTERMONTHLY USER FEE PAYMENT AUTHORIZATION

  • 1. The monthly fee is a continuous plan. This authority is to remain in full and in effect for one (1) year.
    2. The director of the CCCC may at any time adjust the monthly rate applicable to my category of use. I understand that I will receive thirty (30) days prior notice of any such change.
    3. Should my user fee draft not be honored by my bank or credit card for any reason, I understand that I am responsible for any payment plus a $35 CCCC service charge in addition to any bank service fee(s).
    4. I understand that if I wish to terminate or change my user fee plan in any way, I must provide the CCCC with thirty (30) days prior written notice of such change. I further understand I must turn in all CCCC identification cards upon termination of my ongoing user fee plan participation.
    5. I understand that this membership is a yearly contract agreement.
  • I certify that I have read the above five (5) points and fully agree to the terms and conditions of this agreement.
  • USER FEE PAYMENT PLAN (Please initial the appropriate payment plan)
  • MONTHLY USER FEE PAYMENT (Please initial the appropriate payment plan)

  • Please have your preferred payment method ready; we will finalize your payment arrangements during your final membership interview. Please bring your credit / debit card or VOID check with your bank information. 

  • I understand that this membership is a yearly contractual agreement

  • CENTRAL CITY CONVENTION CENTERUSER AGREEMENT

  • Thank you for choosing to use the facilities, services and programs of Central City Convention Center. We request your understanding and cooperation in maintaining both your health and safety and ours by reading and signing the fol- lowing agreement and release of liability form. Any and all users must read and sign below before participating in any activity. No refund will be given for emergencies or inclement weather.

  • AGREEMENT AND RELEASE OF LIABILITY

  • In consideration of being allowed to participate in the activities of CCCC and to use its facilities, equipment, and machinery in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge CCCC and its officers, agents, employees, representatives, executors, and all other from any and all responsibil- ities or liability for injuries or damages resulting from my participation in any activities or my use of equipment or machinery in the above mentioned facilities or arising out of my participation in activities at CCCC. I do also hereby release all of those mentioned and any of these acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of connected with my participation in any activities of CCCC or the use of any equipment at CCCC. (Please initial ____________, ____________, ____________, ____________, ____________)

  • I understand and am aware that strength, feasibility, and aerobic exercise, including the use of equipment, is a potentially hazardous activity. I also understand that fitness activities involve risk of injury and even death and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death. (Please initial ____________, ____________, ____________, ____________, ____________)
  • I do hereby further declare myself to be physically sound and suffering from no condition, impairment, dis- ease, infirmity, or other illness that would prevent participation in any of the activities and programs of CCCC or use of equipment or machinery except hereinafter stated. I do hereby acknowledge that I have been in- formed of the need for a physician's approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery. I also acknowledge that it has been recommended that I have yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise, and use of exercise and training equipment so that I might have recommendations concerning these fitness activ- ities and equipment use. I acknowledge that I have either had a physical examination and have been given a physician's permission to participate, or I have decided to participate in activities and/or use equipment and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities. (Please initial ____________, ____________, ____________, ____________, ____________)
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  • HEALTH HISTORY QUESTIONNAIRE

  • Format: (000) 000-0000.
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  • Regular physical activity is safe for most people. However, some individuals should check with their doctor before they start an exercise program. To help us determine if you should consult with your doctor before starting to exercise with CCCC, please read the following questions carefully and answer each one honestly. All information will be kept confi- dential. Please check YES or NO:
  • Do you have a heart condition?
  • Have you ever experienced a stroke?
  • Do you have epilepsy?
  • Are you pregnant?
  • Do you have diabetes?
  • Do you have emphysema?
  • Do you feel pain in your chest when you engage in physical activity?
  • Do you have chronic bronchitis?
  • In the past month, have you had chest pain when you were not doing physical activity?
  • Do you ever lose consciousness or do you ever lose control of your balance due to chronic dizziness?
  • Are you currently being treated for a bone or joint problem that restricts you from engaging in physical activity?
  • Has a physician ever told you or are you aware that you have high blood pressure?
  • Has anyone in your immediate family (parents/brothers/sisters) had a heart attack, stroke, or cardio- vascular disease before age 55?
  • Has a physician ever told you or are you aware that you have a high cholesterol level?
  • Do you currently smoke?
  • Are you a male over 44 years of age?
  • Are you a female over 54 years of age?
  • Are you currently exercising LESS than 1 hour per week? If you answered no, please list your activities.
  • Are you currently taking any medications?
  • What are your specific fitness goals at Central City Convention Center? (Indicate all that apply)
  • What are your specific health goals at Central City Convention Center? (Indicate all that apply)
  • What motivated you to join Central City Convention Center? (Indicate all that apply)
  • I have read, understood, and completed this questionnaire. Any questions that I had were answered to my full satisfaction.
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  • Physical Activity Readiness Questionnaire (PAR-Q) and You

  • Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with a doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly:
  • 1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
  • 2. Do you feel pain in your chest when you do physical activity?
  • 3. In the past month, have you had chest pain when you were not doing physical activity?
  • 4. Do you lose your balance because of dizziness or do you ever lose consciousness?
  • 5. Do you have a bone or joint problem that could be made worse by a change in your physical activity.
  • 6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart conditions?
  • Do you know of any other reason why you should not do physical activity?

  • If you answered:

  • YES to one or more questions

    Talk to your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered yes.
    • You may also be able to do any activity you want - as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
    • Find out which community programs are safe and helpful for you.

  • NO to all questions

    If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
    • Start becoming much more physically active - begin slowly and build up gradually. This is the safest and easiest way to go.
    • Take part in fitness appraisal - this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively

  • Delay becoming much more active:

    • If you are not feeling well because of a temporary illness such as a cold or a fever - wait until you feel better; or
    • If you are or may be pregnant talk to your doctor before you start becoming more active.
  • Please note: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.
  • Informed use of the PAR-Q: Reprinted from ACSM's Health/Fitness Facility Standards and Guidelines, 1997 by American College of Sports Medicine
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