Membership Form-GL Senior Center

Membership Form

Membership dues are $25 per person and are paid annually. You may pay with cash or check in person or via US mail. If paying by check, please make check payable to Grass Lake Senior Center. We now offer the option of paying online. If paying online, the cost will be $26.00. ($25.00 for membership, $1.00 for credit card convenience fee)

Is this application for?

Renewal (If nothing has changed, please skip to the bottom of the form and sign)

New Membership

First Name

Last Name

Date of Birth

Are you interested in volunteering?

Yes

Address

What Township do you live in?

Phone Number

Previous or Current Occupation

Veteran/branch

Emergency Contact

Relation

Phone Number

Newsletter Delivery

I will pick up newsletter at the Senior Center

Photo Release

I give permission to the Grass Lake Senior Center to use my photo and name for promotional purposes

I DO NOT give permission to use my photos

Membership Guidelines:

Grass Lake Senior Center membership runs on a yearly basis from the date you sign up or renew your membership. Membership benefits include the monthly newsletter and a reciprocal membership with the Chelsea Senior Center including their travel group. It also lets our funders know that you support your senior center!

Members' Code of Conduct:

1. Help provide a friendly and inclusive environment.

2. Be courteous to other seniors, volunteers, visitors, and staff.

3. Promote civility through interactions.

I support and agree that I will uphold these standards and expectations.

Inclement Weather:

The Senior Center does not have a closing policy for inclement weather.

Class Cancellation:

The senior center reserves the right to cancel any classes or programs due to low enrollment and will provide a refund or credit when applicable. If you cancel less than one week before the first class, no refunds will be given, without the instructor's permission. Decisions based on special circumstances will be made at the discretion of the staff or instructor.

Cell Phone Etiquette:

1. Turn the cell phone to LOW or VIBRATE while in the center.

2. Move to an area that offers privacy for both the caller and others at the center.

3. Do NOT use speaker function while in the building.

4. Do not use the camera on the cell phone to take photographs of others or of activities at the center without permission.

Participation Waiver:

In consideration of being allowed to enroll and participate in senior center programs and classes, on site or off site, I agree to personally assume all risks associated in such participation incouding any harm or injury that may result from my participation. I release Grass Lake Senior Center, its agents, insructors, employees and anyone affilated with Grass Lake Senior Center, whether paid or unpaid from liability for any insury or damage tome or my property resulting from my particpation. I understand and agree to hold harmless Grass Lake Senior Center and will not file a claim or action against the Grass Lake Senior Center. This Agreement extends to my successors, heirs and assigns.

Please sign