LSR-7 AQUATIC CENTER - - - Membership and Passes

LS R-7 AQUATIC CENTER | 3498 SW WINDEMERE DRIVE, LEE’S SUMMIT, MO 64082 |
P: [816] 986.1465 | W: http://aq.lsr7.org

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OPEN / LAP Swimming

OPEN / LAP Swimming DAILY PASS $5 MONTHLY PASS $20 LSSD MONTHLY PASS $12 (EMPLOYEES OF LSR7 ONLY) MONTHLY PASS PLUS $40 FAMILY PASS $50 LSSD FAMILY PASS $35 (EMPLOYEES OF LSR7 ONLY) SENIOR DISCOUNT MONTHLY PASS $18
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AQUA AEROBICS:
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Aqua Aerobics is easy on knees and joints, yet still is a great calorie-burning workout you crave.

CLASS OPTIONS:
Deep Water HydroBlast: This is a high intensity class using an combination of cardio and strength workout using weights, bands, and noodles. Shallow Water Toning: This class will improve muscle tone, flexibility, cardiovascular fitness, and increased range of motion. CLASS SCHEDULES: - Mondays from 8a-9a (Deep Water HydroBlast) & 9a-10a (Shallow Toning) - Wednesdays from 8a-9a (Deep Water HydroBlast) & 9a-10a (Shallow Toning) - Fridays from 8a-9a (Deep Water HydroBlast) & 9a-10a (Shallow Toning)
AQUA AEROBICS CLASS PASSES:

AQUA AEROBICS CLASS PASSES: Daily Pass (one time use) $5 Punch Card Pass - 10 Classes $40
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PARTICIPANT(s) INFORMATION
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Participant #1 Information: Participant #1 Information: First Last
Participant #1 Date of Birth Participant #1 Date of Birth / MM / DD YYYY
Participant #1 Age
Participant #2 Information: Participant #2 Information: First Last
Participant #2 Date of Birth Participant #2 Date of Birth / MM / DD YYYY
Participant #2 Age
Parent / Guardian Name (unless Participants 18+) Parent / Guardian Name (unless Participants 18+) First Last
Address
City
State
ZIP
Must be 5 digits. Currently Entered: 0 digits.
Phone Phone - ### - ### ####
Email
Confirm Email - To Receive Confirmation Email and a Copy in email format and a PDF of your Submission. The Aquatic Center will also receive a copy of your Submission in email format and PDF.
MEDICAL INFORMATION:

If NO, the Participant(s) listed above does/do not take any medications or have any additional information to provide.

If YES, Please list any medications or additional information needed for Participant(s):
If YES to MEDICAL INFORMATION above:
Please list any medications or additional information needed for Participant(s):
PARENT/GUARDIAN PERMISSION FOR PUBLICATION OF PICTURES:
I give my permission for the Lee’s Summit School District and/or Lee’s Summit R-7
Aquatic Center to post the participants picture (without name) on the Internet or in a printed advertisement. Occasionally a group picture with the participant may be used, but participants will never be identified by name in group pictures.
PLEASE MARK IF YOU HAVE READ AND UNDERSTOOD:
I give permission for the above Publication Guidelines
Refund And Cancellation Policy
PLEASE MARK IF YOU HAVE READ AND UNDERSTOOD:
That you have read and reviewed the refund policy on the website (link above).
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Lee Summit R-7 Aquatic Center
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RELEASE OF LIABILITY AND ASSUMPTION OF RISK:

IN CONSIDERATION OF being permitted to use the swimming pool and facilities,
the undersigned agrees to the following:

1. Participant will abide by all policies and procedures regarding swimming pool activities;
2. Risks and dangers exist during swimming activities. These risks include physical injuries, psychological injuries and even the possibility of loss of life;

3. Each person is responsible for his/her actions and those of his/her children in the swimming pool and around the pool area and agrees to abide by all posted rules, policies and procedures in order to maintain the utmost level of safety;

4. I hereby assume all of the risks of participating in the swimming pool activities and will hold the owner/operator and its employees, agents, officers, trustees and affiliates harmless from any and all liability, actions, demands, damages, expenses, costs, claims and causes of action of any possible nature in respect of injury, death loss or damage to myself, child or property however caused as a result of or in any way relating to my activities in the swimming pool and around the pool area;
5. I further agree to indemnify and hold harmless the owner/operator, its employees, agents, officers, trustees and affiliates from and against any and all liability incurred as a result of or in any manner related to my participation in swimming pool activities; 6. If, despite the signing of this waiver, a
lawsuit is brought against the owner/operator, its employees, agents, officers, trustees or affiliates in relation to participation in the swimming pool activities, I agree to pay for any and all court costs and attorneys fees incurred as a result of such litigation;
7. I also declare that neither I nor my children, if applicable, are under the influence of any chemical substance including alcohol at the time of the signing of this release or at the time of participation in pool activities;
8. I agree that if any provision of this release is found to be unenforceable or invalid in any way, the remaining provisions will remain in force and effect;
9. I fully understand that swimming pool activities involve a certain level of risk of injury. My participation in these activities and my signing of this waiver are completely voluntary.
PARTICIPANT/PARENT/GUARDIAN Signature for Liability Waiver:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

LSR-7 AQUATIC CENTER - - - Membership and Passes

LSR-7 AQUATIC CENTER - - - Membership and Passes

_______________________________________________________________ PARTICIPANT(s) INFORMATION _______________________________________________________________

_______________________________________________________________ Lee Summit R-7 Aquatic Center _______________________________________________________________

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PARTICIPANT(s) INFORMATION
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Lee Summit R-7 Aquatic Center
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