Name ______________________________________________Spouse___________________________________________
Address ________________________________________City______________________ State/Zip ___________________
Telephone (Home) __________________(Cell)_________________E-mail address_________________________________
Subdivision_____________________________________ Moved from___________________________________________
Hobbies/Interests_________________________________________________________ Member since (year) ____________
Birthday of member (month/day) ____________ Receive newsletter by:(please check one) Web site____ Regular mail_____
Names children, birth dates/ages__________________________________________________________________________
I accept the risks and hazards that may result from participation in any function offered by the Apex Newcomers and Friends Club including, but not limited to, broken bones, lacerations, bruises, and muscle strains/sprains. With consideration I hereby waive, release, absolve and agree to hold harmless, the Apex Newcomers and Friends Club and its officers or agents from any claims arising out of injury to myself. I further give permission for proper emergency care to be rendered should I be in need of such services.
Signature of Member____________________________________________Date___________________________________ Emergency Contact: Name_______________________________________Phone__________________________________
On behalf of____________________________ (list name of spouse) I accept the risks and hazards that may result from his/her participation in any function offered by the Apex Newcomers and Friends Club including, but not limited to, broken bones, lacerations, bruises, and muscle strains/sprains. With consideration I hereby waive, release. Absolve and agree to hold harmless, the Apex Newcomers and Friends Club and its officers or agents from any claims arising out of injury to my spouse. I further give permission for proper emergency care to be rendered should he/she be in need of such services.
Signature of Member _________________________________________________________Date______________________ Emergency Contact: Name_____________________________________________________Phone_____________________
I, the parent/legal guardian of______________________________________________________(list all children’s names) hereby give approval for my child(ren) to participate in any function offered by the Apex Newcomers and Friends Club. As part of this approval, I acknowledge I may have the opportunity to review premises and the activity equipment. I accept the risks and hazards that may result from participation including, but not to broken bones, lacerations, bruises and muscle strains/sprains. With consideration, I hereby waive, release, absolve and agree to hold harmless, the Apex Newcomers and Friends Club and its officers or agents from any claims arising out of injury to my child(ren). I further give permission for proper emergency care to be rendered to my child(ren) should I not be available.
Signature of Parent/Legal Guardian______________________________________________Date______________________ Emergency contact: Name___________________________________________________Phone_______________________
Prospective members are welcome to attend two meetings/activities of Newcomers with non-refundable dues of $25 payable on the third visit. The $25 dues include the monthly newsletter and directory. Additional fees and charges may apply for events.
Complete this form and mail with $25 check (payable to Apex Newcomers and Friends Club) to: Apex Newcomers and Friends Club
c/o Apex Chamber of Commerce
220 North Salem Street
Revised 4/03/SV Apex, NC 27502