Lower Columbia College Fitness Center

Lower Columbia College Fitness Center

Assumption of risk, release and medical consent for exercise. Assumption of risk form is required for all membership options. Under age 18 requires parent/guardian signature.
Email*
example@example.com

Facilities use risk:

I, the undersigned, represent that I am physically able and qualified to participate in physical activities and use of the facilities at the Lower Columbia College Fitness Center (LCCFC). I acknowledge and agree that LCCFC’s services and facilities are to be used “AS IS,” and shall be undertaken at my sole risk and personal responsibility. I understand that there are inherent risks involved in physical activities and the use of the LCCFC, including but not limited to serious injury to all bones, joints, ligaments, muscles, tendons, and other aspects of the muscular-skeletal system and serious injury or impairment to other aspects of my body, health, and well-being including partial or total disability, paralysis and death as well as other foreseeable and unforeseeable damages, including damage to property. I understand that there is also a possibility that I may be exposed to bodily fluids (i.e. blood) which may contain various contagious or harmful bacteria's, viruses, pathogens, or other agents including Hepatitis B, HIV, etc. I acknowledge that I understand and have been informed of the risks associated with exercise and the use of exercise equipment and the facilities at the LCCFC. I accept that this consent form does not spell out every possible risk or complication that I may suffer or incur. I KNOWINGLY AND VOLUNTARILY ACKNOWLEDGE MY FULL UNDERSTANDING OF ANY AND ALL POSSIBLE RISKS AND ASSUME ALL SUCH RISKS AS MY PERSONAL AND SOLE RESPONSIBILITY.
Please type your full name (first and last) if you have read and understand the above Facilities use risk.*

First NameLast Name

Voluntary Consent and Release:

In consideration for my use of the facilities at the LCCFC, I, the undersigned, hereby waive and relinquish any and all claims, rights and cause of action that I may have against LCC, its board members, employees, agents, successors and assigns, for any injuries, damages, or death to me arising out of the use of the LCCFC, whether or not arising from acts of active or passive negligence on the part of LCC, its employees or agents. I hereby indemnify and hold harmless Lower Columbia College, its board members, employees, agents, successors and assigns, from any and all claims, demands, actions, costs and or causes of action. The terms hereof shall serve as a release and assumption of risk for myself, my heirs, executors and administrators and for all members of my family both now and in the future.
Please type your full name (first and last) if you have read and understand the above Voluntary Consent and Release.*

First NameLast Name

Emergency Medical Consent for Treatment:

I, the undersigned, authorize the staff at Lower Columbia College to act for me in any emergency situation requiring medical attention. I will be personally and solely responsible for all charges and fees incurred in obtaining medical attention including but not limited to care by health care professionals, hospital care, ambulance and or other services regardless of whether or not my medical insurance will cover such charges and fees including any and all attorney’s fees and cost of defense relating to any injuries and or damages or death arising out of or resulting from my use of the LCCFC, its services, equipment, and or facilities. I hereby hold harmless and agree to indemnify Lower Columbia College, its employees, agents, successors and administrators and assigns from decisions to seek emergency medical treatment on my behalf. I certify that I am of lawful age and am competent to sign this statement of Assumption of Risk, Release and Medical Consent for Exercise.
I FULLY UNDERSTAND AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND MEDICAL CONSENT FOR EXERCISE IN CONSIDERATION FOR MY USE OF THE FACILITIES AT THE LCCFC. I HAVE CAREFULLY READ THIS DOCUMENT, UNDERSTAND ITS CONTENT AND SIGNIFICANCE, AND AM FULLY INFORMED ABOUT THE FACILITIES AT THE LOWER COLUMBIA COLLEGE FITNESS CENTER AND AM SATISFIED THAT I CAN SAFELY USE THE FACILITIES AND EQUIPMENT AT THE LCCFC.
Please type your full name (first and last) if you have read and understand the above Emergency Medical Consent for Treatment.*

First NameLast Name

Procedures and Policies

Please click on the below policy and procedure forms to download the PDF's to your device. Users of the LCC Fitness Center are required to read and adhere to all policies and procedures provided below.
Please type your full name (first and last) if you have downloaded, read, and understand the above provided policies and procedures.*

First NameLast Name

Member Information
Name*

First NameMiddle InitialLast Name
Form Completion Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ctcLink #*
Date of Birth (DOB)*

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (first and last)
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Assumption of risk, release, and medical consent for exercise.

Assumption of risk, release and medical consent for exercise. Assumption of risk form is required for all membership options. Under age 18 requires parent/guardian signature.
Electronic Signature*

First NameMiddle InitialLast Name
If under the age of 18, please have your parent/guardian provide their electronic signature below.
Parent or Guardian phone number
Please enter a valid phone number.Format: (000) 000-0000.
Lower Columbia College does not discriminate on the basis of sex and prohibits sex discrimination in any education program or activity that it operates, as required by Title IX, including in admission and employment. Lower Columbia College provides equal opportunity in education and employment and does not discriminate on the basis of race, color, national origin, citizenship or immigration status, age, perceived or actual physical or mental disability, pregnancy, genetic information, sex, sexual orientation, gender identity, marital status, creed, religion, veteran or military status, or use of a trained guide dog or service animal as required by Title VI of the Civil Rights Act of 1964, Title VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Sections 504 and 508 of the Rehabilitation Act of 1973, the Americans with Disabilities Act and ADA Amendment Act, the Age Discrimination Act of 1975, the Violence Against Women Reauthorization Act and Washington State's Law Against Discrimination, Chapter 49.60 RCW and their implementing regulations. All inquiries regarding compliance with Title IX, access, equal opportunity and/or grievance procedures should be directed to Vice President of Foundation, HR & Legal Affairs, 1600 Maple Street, PO Box 3010, Longview, WA 98632, title9@lowercolumbia.edu, Phone number, (360) 442-2120, Phone number/TTY (800) 833-6388. The notice of nondiscrimination is located at https://lowercolumbia.edu/disclosure/non-discrimination/.
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Lower Columbia College Fitness Center

Facilities use risk:

Voluntary Consent and Release:

Emergency Medical Consent for Treatment:

Procedures and Policies

Member Information

Assumption of risk, release, and medical consent for exercise.