Gym Membership Registration SF Sandbox

EPIC is pleased to open new Gym Facility for members and non-members living in Plano, Murphy, Richardson, Wylie, Sachse, Allen and Garland area.

There are two types of Memberships avaialble:

Individual (Age 18+)
Family

The Gym Membership Registration is a three step process:

Submit this form for all members in your household.
Take Picture for the Gym ID Card (This step must be done in person at EPIC office).
Pickup Gym ID Card. (This step must be done in person at EPIC office after 1 week of a picture taken).

Notes

You will be required to present your state identification card at the time of member ID pickup.
All members above 12 years are required to have their picture taken for the Gym ID card. The Card will be provided inshaAllah after 1 week of a picture taken.

Gym Membership Type*

Individual (Gym Membership)Family (Gym Membership)

Household Name Copy*

Your family Alias (e.g. Rehman Family)

Name (Head of the household)*

First NameLast Name

Date of Birth*

MonthDayYear

Date

#Days

#Age

Email*

example@example.com

Phone Number*

Address*

Street

City*

State*

Zip Code*

(Must be from Allen,Murphy,Parker,Plano,Richardson,Wylie,Sachse,Garland)

List additional family members*

**Exclude Head of the household

Member #1 First Name*

Member #1 Last Name*

Member #1 Date of Birth*

MonthDayYear

Member #1 Email (Optional)

example@example.com

Member #2 First Name*

Member #2 Last Name*

Member #2 Date of Birth*

MonthDayYear

Member #2 Email (Optional)

example@example.com

Member #3 First Name*

Member #3 Last Name*

Member #3 Date of Birth*

MonthDayYear

Member #3 Email (Optional)

example@example.com

Member #4 First Name*

Member #4 Last Name*

Member #4 Date of Birth*

MonthDayYear

Member #4 Email (Optional)

example@example.com

Member #5 First Name*

Member #5 Last Name*

Member #5 Date of Birth*

MonthDayYear

Member #5 Email (Optional)

example@example.com

Member #6 First Name*

Member #6 Last Name*

Member #6 Date of Birth*

MonthDayYear

Member #6 Email (Optional)

example@example.com

Member #7 First Name*

Member #7 Last Name*

Member #7 Date of Birth*

MonthDayYear

Member #7 Email (Optional)

example@example.com

Member #8 First Name*

Member #8 Last Name*

Member #8 Date of Birth*

MonthDayYear

Member #8 Email (Optional)

example@example.com

Member #9 First Name*

Member #9 Last Name*

Member #9 Date of Birth*

MonthDayYear

Member #9 Email (Optional)

example@example.com

Family Description

WAIVER OF LIABILITY FOR EPIC COMMUNITY CENTER

I/We hereby understand and acknowledge that the use of multi purpose hall, sports facilities, training, programs and sports events held at the East Plano Islamic Center [EPIC] may expose me to many inherent risks, including accidents, injury, illness, or even death. I/We assume all risk of injuries associated with participation including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or
humidity, and all other such risks being known and appreciated by me.
I/We hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with participation in activity. I/We acknowledge that I am physically fit and mentally capable of
performing the physical activity I choose to participate in.
After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and the EPIC furnishing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD
HARMLESS, WAIVE AND RELEASE the EPIC, its officers, agents, employees, organizers, representatives, and successors from any responsibility, liabilities, demands, or claims of any kind arising out of my participation
in the EPIC training, programs and/or events.

By my signature I/We indicate that I/We have read and understand EPIC Community Center Policies and Guidelines. I am at least 18 or above and aware that this is a waiver and a release of liability and I voluntarily agree to its terms.*

I agreeI disagree

To sign the wavier, the Head of the Household age must be at least 18 or above.

Member, Parent , Guardian Signature*