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Recreation Center Membership Agreement

  1. Primary Contact on Account Information

  2. Emergency Contact Information

  3. List all Members on the Account

    Please include the information for the primary account holder

  4. Gender*

  5. Gender

  6. Gender

  7. Gender

  8. Gender

  9. Gender

  10. Gender

  11. Type of Membership

    Please choose one from each selection below

  12. Residency*

  13. Type*

    Membership rates are listed as resident/non-resident

  14. Membership Acknowledgement*

    I understand that once this form is submitted I will be contacted by the Little Elm Recreation Center within one business day to finalize my membership. I understand that I must provide payment before my membership is active. I agree to follow all rules, guidelines, and regulations put forth by the Little Elm Recreation Department and failure to do so may result in my removal from the facility.

  15. Credit Card Information

  16. If no day is given, please put 01

  17. Type of Card*

    Please note we only accept these types of credit cards

  18. Credit Card Authorization*

    The Town of Little Elm is hereby authorized to draft my credit card, as listed above, on the due date of each month, or year for my monthly or annual Little Elm Recreation Center membership dues. I understand that my account will be paid by draft until such time as I provide written notification to the Little Elm Recreation Center to cancel this authorization.

  19. Waiver of Liability*

    For and in consideration of my/our participation in the programs, membership, and activities offered by the Town of Little Elm (hereinafter referred to as “the Town”), I hereby agree to release, acquit, hold harmless, forever discharge, and waive any and all claims that I/we may have against the Town of Little Elm, its officials, officers, agents, representatives, employees, and volunteers in whole or in part, in both their private and public capacities (hereinafter collectively referred to as “releasees”) from any and all actions, causes of actions, claims, demands, damages, lawsuits, costs, loss of services, expenses, and compensation, whether known or unknown, on account of, or in any way arising out of or connected in any manner with my/our participation in the activities, including, but not limited to, liability, damages, injury (including death), property damage, legal fees and/or costs caused by or related to any negligent or intentional act of releasee. I further agree pictures taken of me and/or the registrant during the activities may be used by the Town for promotional purposes in the activity guide, brochures, flyers, news releases, or the Town website. All cash or check refunds require a minimum of 6 weeks processing. Refunds will be mailed to account address. All class cancellations must be done 5 business days prior to the start of the class. All memberships paid in full will receive a prorated refund from the day the membership is cancelled.

  20. Please provide a picture of your driver's license or utility bill matching the name of the primary account holder to the address listed above. This will be used to verify residency before staff can finalize your membership.

  21. Leave This Blank:

  22. This field is not part of the form submission.