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 \nName_  \n   \nStreet Address_  \nCity  \nZip  \n   \n   \n   \n_E-mail  \nTownship  \n   \n   \nHome Phone  \nCell Phone_  \n   \n   \nNewsletter Preference:  Email □HomeBirthdate  \n   \nScan\\#_  \nRenew Active ID\\#_  \n   \n   \nOther Health Services ID\\#_  \n   \nEmergency Contact Name:  \nRelationship.  \n   \n   \nHome Phone  \nCell Phone  \n   \n   \nConfidential information (please complete to insure financial support from our funders):  \nGender and Bottom of Form  \nMaleFemale  \nOther  \nEthnicity  \nAfrican AmericanAmerican Indian Asian □Caucasian Hispanic □other100%150%200%Annual Income  \n   \n   \n   \n□□$12,880□over $25,760$19,320Single:Less than:  \n□$17,420□□$21,130over $34,840Married:Less than:  \nHow did you hear about Forks Senior Center?  \n□Newspape Ssmor Tme wesane fFye Frena orfmu  \n□FSCMember  \n# What are your special interests?□Special Events □Computers □Education\n\n□Arts&Crafts □Health &Fitness Travel  \n# Where would you be interested in volunteering?\n\nFundraisers &Eventsset Up for Functions (tables &□Reception Deskchairs)  \n□Van Driver for Trips □Cleaning/Maintenance  \n□Luncheon or Potluck Dinners  \n● FSC Membership is available for persons age 60+.  \n·Membership Dues are $75.00 annually and are due on January 1  \n·Payment plan is available for those who qualify (2 payments of$37.50 due January 1 and June 1)  \n·Subsidies can be requested for those who fall below the 100%of the federal poverty line and canprovide appropriate documentation.Contact the Office Manager foradditionalinformation.  \nForks Senior CenterMEMBERDISCLAIMER AND WAIVER OF LIABILITY  \nForks Senior Center(FSC)facilities,programs,and services are for use by ourmembers and registered guests.FSC does not have professional trainers orattendants on duty in its fitness center or other areas of the facility,and FSCemployees are not responsible for providing advice of any kind regarding the use ofexercise equipment or participation in exercise or other health-and-wellnessclasses or activities.  \nI,the undersigned,understand that participation in FSC's on-site or off-siteactivities,programs,or services could result in severe injuries,including paralysisor death,and I assume any and all such risk.In consideration for allowing me touse FSC facilities,I hereby for myself,my heirs,executors,and administrators,waive and release all rights and claims for losses and damages I may have againstFSC and its representatives,successors and assigns for any and all injuries sufferedby me as a result of my use of these facilities.  \nI also agree to hold harmless FSC from and against all liability because of damage tomy property while engaged in FSC activities,programs,and services on-site andoff-site.FSC shall not be liable for any actions taken or injuries incurred in theseareas.  \nSignature_                                            \nDate_        \n\n| Consent to use photos,audio,digital,or video images and artwork.  \u003Cbr>I hereby consent to photographs/audio or video footage and/or other images of myself or my  \u003Cbr>artistic works being utilized by Forks Senior Center for any of the following purposes:  \u003Cbr>● Social media  \u003Cbr>·  Marketing and promotional activities  \u003Cbr>● website  \u003Cbr>·  newsletters and publications(electronic or hardcopy)  \u003Cbr>·  or other specified use   |\n| --- |","cbCaic3h9l1KmpjU","https://ap.wps.com/l/cbCaic3h9l1KmpjU","pdf",108504,"English","# Membership Application Information\n## Applicant Details and Confidential Information\n## Contact, Preferences, and Identifiers\n## Emergency Contact\n## How You Heard About FSC, Interests, and Volunteering\n## Membership Dues, Payment Plan, and Subsidies\n# Member Disclaimer and Waiver of Liability\n# Consent for Photo/Audio/Video and Artwork Use","[{\"question\":\"Who is eligible to apply for Forks Senior Center membership?\",\"answer\":\"Membership is available for persons age 60+.\"},{\"question\":\"What are the membership dues and payment due dates?\",\"answer\":\"Membership dues are $75.00 annually and are due on January 1.\"},{\"question\":\"What does the member disclaimer and waiver of liability cover?\",\"answer\":\"It explains that participation could result in severe injuries, including paralysis or death, and the applicant waives and releases claims and agrees to hold the center harmless for certain losses, damages, and liabilities.\"}]","Forks Senior Center - Membership Application | PDF",1791007611]