HTML Membership Form

Membership Application

Broadview Heights Parks and Recreation Department

9543 Broadview Road, Broadview Heights, OH 44147 (440) 838-4522 www.bhrec.org

(All Memberships are non-refundable and non-transferable)

Annual Memberships cannot be renewed more than 30 days prior to expiration

(Must show 2 proofs of residency at time of registration)

Resident                                 Yearly        Monthly
(Must show 2 proofs  of residency at time of registration)
 Youth (up to 18)                    $98                   $16
College (18-23)                      $98                   $16
 Senior (60+)                         $90                   $14
 Veteran**                              $90                   $14
 Adult (19-59)                         $200                 $26
 Family*                                 $335                $46


Non-Resident                             Yearly       Monthly
  Youth (up to 18)                        $211               $26
  College (18-23)                         $211               $26
  Senior (60+)                             $197               $24
  Veteran**                                 $197               $24
  Adult (19-59)                            $350               $46
  Family*                                    $608               $77


Corporate***                          Yearly        Monthly
  Youth (up to 18)                     $162              $21
  College (18-23)                      $162              $21
  Senior (60+) / Veteran**         $150              $19
  Adult (19-59)                         $266              $35
  Family*                                 $450              $60

*Family membership consists of 2 adults and their dependent children 18 and under living at the same address.

**Veteran memberships – Must provide ID and DD-214

***Corporate memberships are for non-residents who are employed by a business located in the City of Broadview Heights. Applicant must provide a copy of a current pay stub with employee name and business address at the time of application and with each renewal.

Primary Member – NAME:                                                                                            DOB:                         M or F
Address:                                                                                                  City:                                                   Zip:
Home Phone:                                         Cell Phone:                                         Email:
Secondary Adult – NAME:                                                                                             DOB:                           M or F
Email:                                                                                              Cell Phone:
Children 18 and under                                                                                                                      Staff Use Only
1.                                                                                       DOB:                            M or F                               (BC / RC / DL)
2.                                                                                       DOB:                            M or F                               (BC / RC / DL)
3.                                                                                       DOB:                            M or F                               (BC / RC / DL)
4.                                                                                       DOB:                            M or F                               (BC / RC / DL)
Medical Information:
Emergency Contact:                                                    Phone:                                      Relationship:
Current annual members receive one month free for referring a new member who purchases an annual membership. Referred by: _______________________________








Youth (up to 18) $98 $16 Youth (up to 18) $211 $26

College (18-23) $98 $16 College (18-23) $211 $26

Senior (60+) $90 $14 Senior (60+) $197 $24

Veteran** $90 $14 Veteran** $197 $24

Adult (19-59) $200 $26 Adult (19-59) $350 $46

Family* $335 $46 Family* $608 $77

Corporate*** Yearly Monthly *Family membership consists of 2 adults and their dependent

children 18 and under living at the same address.

**Veteran memberships – Must provide ID and DD-214

***Corporate memberships are for non-residents who are

employed by a business located in the City of Broadview Heights.

Applicant must provide a copy of a current pay stub with employee

name and business address at the time of application and with each

renewal.

Youth (up to 18) $162 $21

College (18-23) $162 $21

Senior (60+) / Veteran** $150 $19

Adult (19-59) $266 $35

Family* $450 $60

Primary Member NAME: DOB: M or F

Address: City: Zip:

Home Phone: Cell Phone: Email:

Secondary Adult NAME: DOB: M or F

Email: Cell Phone:

Children 18 and under Staff Use Only

1. DOB: M or F (BC / RC / DL)

2. DOB: M or F (BC / RC / DL)

3. DOB: M or F (BC / RC / DL)

4. DOB: M or F (BC / RC / DL)

Medical Information:

Emergency Contact: Phone: Relationship:

Current annual members receive one month free for referring a new member who purchases an annual

membership. Referred by: _______________________________

Waiver and Release: The undersigned does hereby waive, release, and hold harmless and indemnify the City of Broadview Heights and the Broadview Heights Parks and

Recreation Department, their organizers, officers, employees, agents, and sponsors for any and all claims for damage of personal injury to me or loss of property that may be

cause by any act or failure to act on the part of the City of Broadview Heights, the Broadview Heights Parks and Recreation Department, their organizers, officer, employees,

agents and sponsors. The undersigned further assumes the risk of all dangerous conditions in and about the City of Broadview Heights, the Broadview Parks and Recreation

Department property both real and personal and waive any and all specific notice of the existence of such dangerous conditions, if any. By participating in or attending any Parks

and Recreation events I agree to allow publication of any photograph taken of myself/my child for advertising purposes.

Signature _______________________________________________________________ Date _____________________

Broadview Heights Parks and Recreation

STAFF USE ONLY

Verification - Photo: ______ Address: _______ College: _______ Veteran DD 214: _______ Corporate: _______

Corporate Business Address: _______________________________________________________________________

Children/Veteran Status Verified in RT: _______ HH Info Updated in RT: _______

Payment Type: Credit Card / Cash / Check # _______ RecTrac Entry By: _______

Broadview Heights Parks and Recreation Department

RECREATION CENTER MEMBERSHIP INFORMATION

Membership Benefits

 Free use of fitness center

 Free use of pool, gymnasium and game room during all open hours

 Discounts on programs and activities

 Discounts on room rentals and birthday parties

Recreation Center Rules and Policies

1. No food or drink in gym.

2. Only scuff-resistant shoes are permitted in gym.

3. The Broadview Heights Recreation Center is an alcohol and tobacco free building.

4. Males under the age of 6 may use the women’s locker room with an adult. There are no females permitted in the men’s locker

room at any time - please use the family locker room.

5. No one under the age of 15 may enter the fitness center, with the exception of 13 and 14 year olds who have taken the Youth

Fitness Training course. After course completion 13 and 14 year olds must be accompanied by a parent while utilizing the

fitness center.

6. Children under 13 years of age must be accompanied by a parent or guardian in all areas of the facility unless they are enrolled

in an organized program or activity.

7. All children under age 7 MUST be accompanied by an adult in the water, within arms-reach, at all times.

8. Proper fitness attire and footwear must be worn in the fitness center - no sandals, cut-offs, sports bras or jeans permitted.

9. The Broadview Heights Recreation Department is not responsible for lost or stolen articles. It is strongly recommended that

you do not bring any valuables into the center. There are lockers in the locker rooms for your use, however, items may not be

locked overnight. Any locks remaining at the end of the night will be cut off.

10. Please read the pool rules and follow them accordingly.

11. Memberships are non-refundable and non-transferable.

12. If you are a member using the facility you must punch in your code number at the front desk or in the fitness center.

13. Game room equipment must be signed out and returned to the front desk.

14. The following activities will not be tolerated and may be subject to suspension, expulsion, and/or criminal prosecution:

A. Fighting E. Disorderly conduct

B. Foul language F. Damaging equipment or property

C. Loitering (inside or outside) G. Disregarding the staffs' enforcement of the rules

Pool Rules

1. NO DIVING PERMITTED IN THE POOL!

2. Only special swim diapers are permitted in the pool.

3. Soap showers are required before using the pool.

4. Persons with communicable diseases or infectious conditions such as open sores or eye infections shall not be permitted to use

the pool.

5. Proper bathing attire required (swim suits are the only acceptable attire).

6. Spitting or polluting the pool water or related facility is prohibited.

7. Glass containers are not permitted in the pool area.

8. No eating in the pool area.

9. US Coast Guard Approved Life Jackets are permitted. An adult must be within arms-reach of anyone utilizing a lifejacket. No

other flotation devices are permitted.

10. Sandals are permitted on the deck all year - no athletic shoes on deck.

11. No running.

12. Children under age 13 years must be accompanied by an adult or guardian in the pool area.

13. Children under age 7 MUST be accompanied by an adult in the water at all times.

14. Please wait for the lifeguard to signal before entering the water.

15. Sauna is for adults 18 and over. All posted sauna rules must be followed.

16. Lifeguards are responsible for enforcing rules that in their judgment will help maintain a safe environment.

Failure to adhere to these and any other rules and policies may result in suspension, expulsion, or criminal prosecution. The Broadview Heights

Recreation Center Staff reserves the right to add, change or delete rules, which in our judgment, will help maintain a safe environment for your use and

pleasure.

Signature_______________________________________________________________ Date ______________________________________