Buhl Club Membership Registration Form

28 N. Pine Ave., Sharon, PA 16146 Phone: 724-981-3700

Membership Application

Name*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Date of Birth*

Date

E-mail*

Phone #:*

Area CodePhone Number

Emergency #:

Area CodePhone Number

For Family Memberships Only (include last name if different from applicant)

Spouse:

First NameLast Name

Gender:

Date of Birth:

Date

Child 1:

First NameLast Name

Gender:

Date

Child 2:

First NameLast Name

Gender:

Date of Birth:

Date

Child 3:

First NameLast Name

Gender:

Date of Birth:

Date

How did you hear about the Buhl Club?

Have you been a member of another fitness center?

If Yes, which one?

Why are you joining the Buhl Club?

Membership Options:*

Family Membership (2 or more)$50.00

Options:

Adult Membership$30.00

Options:

College Membership$20.00

Options:

Teen Membership (Grades 9-12)$15.00

Options:

Youth Membership (Grades 0-8)$10.00

Options:

Terms and Conditions:

I understand and expressly agree that my use of the BCRC, or any of its facilities, involves the risk of injury to me or any of my guests, whether caused by me or not. I understand that these risks can range from minor injuries to major injuries including death. In consideration of my participation in the activities and use of the facilities and equipment of the BCRC, I hereby voluntarily release, waive, discharge and hold harmless the BCRC, its officers, directors, managers, members, agents, employees and independent contractors from any and all claims, demands, and causes of action arising from my participation and/or use of the facilities and equipment of the BCRC, including but not limited to claims for bodily injury, pain and suffering, emotional distress, property loss, economic loss or any other loss.

I further undertand and acknowledge that the BCRC does not manufacture fitness or other equipment in its facilities, but purchases and/or leases equipment and therefore I agree that I shall not hold the BCRC liable for defective products.

I agree to comply the BCRC's membership policies and club rules that may be communicated to me from time to time either in writing, through club signage, or orally. The BCRC may, in its sole discretion, nmodify the policies and any club rule without notice, and at any time. The BCRC reserves the right to refund the pro-rated cost of unused services and terminate my membership immediatly for violation of any membership policy of club rule. By signing this agreement, I acknowledge and agree to all of the terms in this agreement.

Co-signer Authorization & Minor Waiver (please initial each statement to acknowledge that you have read, agree to and understand each statement): Parent/Guardian: In exchange for the BCRC allowing my minor child to purchase a membership, or use the BCRC facilities an/or equiptment.

I agree to the Release of Liability and Assumption of the Risk clauses in this agreement and I agree to defend and indemnify the BCRC to the fullest extent permitted by the law for any claim brought by my minor child against the BCRC. I also promise to pay any financial obligation that my minor child does not pay for any reason and ackowledge that the banking information above is my account.

Please complete:*

By clicking the "Pay Now" button you are submiting your online application and will be re-directed to Paypal to submit your payment. Once we recieve your payment, please allow 1 to 2 business days to process your Membership.

Thank you!