Current Adult Registration Form

Please fill out this form and click submit.
Main
 
 
 
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Primary Household
 
 
 
 
 
 
Emergency Contact
 
 
 
Medical Info
Should a medical emergency occur while you are at The Ladder, could we provide the medical responders with your medical history?  If "Yes" please provide the info below.
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Our facility accepts Silver Sneakers and Prime as payment for membership fees. Does your medical insurance include Silver Sneakers or Prime?
Please select all that apply.
Adult Consent Form

Liability Release Statement:
I acknowledge that I will be participating at my own risk and I hereby indemnify and hold harmless TLCC, its directors, officers, employees, volunteers, agents, and affiliates from liability for personal injury or damage to personal property arising out of participation in, and transportation associated with TLCC.

Media Release Statement:
I grant permission to TLCC to use my likeness, voice and words in television, radio, films, newspaper, magazines and other media, and in any form not heretofore described, for the purpose of advertising or communicating the purpose and activities of TLCC and appealing for funds to support such activities.  If you choose No, it is your responsibility to remove yourself when group pictures are being taken.

Please select one option.
(TLCC office will print to get your official signature in person at The Ladder.)

Signature:
Date: 

Newsletter and One Call Notification System
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Please select one option.
Adult Rules

1. A person may participate at TLCC when all registration forms are complete.  Once you have filled out the forms, you become a member of TLCC.

2. It is mandatory that all members sign in when they arrive at TLCC.  

3. Treat Ladder personnel and peers with respect and consideration.  Please refrain from swearing, putting down others, teasing, bullying and confronting others.

4. We expect all equipment and property be treated with respect and care.  Members should return any equipment in the same condition upon leaving TLCC.  Members will be held responsible for any property damage caused at TLCC.

5. Clean up after yourself.  Throw away trash.  Liquids left in cups should be dumped in sink before throwing cups in trash.  

6. For your safety, guns, knives and other items used as weapons are not allowed.

7. Smoking, vaping, and gambling are prohibited on TLCC property.

8. Members and guests must not be under the influence of, be in possession of, supply others with, or consume any drug or alcoholic beverage while on TLCC property.  If TLCC has any reasonable basis to believe that this rule is being violated, adults will be asked to leave TLCC premises, if the adult does not comply or is driving a car, police will be contacted.

9. If you bring personal property into TLCC, please secure and care for your property.  TLCC is not responsible for loss, damage, or theft of any member’s personal property.

10. Be considerate and inclusive to others.



Adult Dress Code

When a dress code violation occurs, the member will be asked to change clothing, turn the shirt inside out or be asked to leave for the day.  A member will be suspended for repeated acts of abusing the dress code.


The following styles or manners of dress are prohibited:


1.Any type of dress that is immodest and unsanitary or deviates from the accepted standards of our schools and community.


2.Hoods, sunglasses, and spike or chain-style jewelry.


3.Hats, kerchiefs or do-rags that cover the top of the head. (verified religious exceptions are allowed.)


4.Clothing with sexual connotations, inappropriate language or demeaning remarks.


5.Exposed bras or exposed/revealing cleavage.


6.Exposed midriffs, backs, or underwear.


7.Clothing and/or paraphernalia that may appear to be gang-related.


8.Skirts and shorts that are shorter than fingertip length.


9.Pants or cut-offs with holes in the groin area.


10.Clothing with messages that advertise drugs, alcohol, tobacco, smoking, gambling, sex, promotes violence, or other illicit behaviors.   (Some messages on clothing have multiple meanings).


11.All tops that are not long enough to be tucked in. 


12.Slippers. (All members are required to wear appropriate footwear. Shoes must be worn in large group games.)


I hereby agree to abide by all the adult rules and adult dress code as designed by the staff to make TLCC a structured, safe and pleasant environment
(TLCC office will print to get your official signature in person at The Ladder.)

Signature:
Date:



***TLCC does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or services.

Network Computing/Email Policy & Contract

TLCC of Shelby is responsible for securing its network and computing system to a reasonable and economically feasible degree against unauthorized access and/or abuse, while making them accessible for authorized and legitimate users.  This responsibility includes informing users of the expected standards of conduct and the disciplinary or legal consequences for not adhering to them.  Any attempt to violate the provisions of this policy will result in disciplinary action and possible revocation of use regardless of the success or failure of the attempt.


 


Once a user is granted permission to access the electronics network facilities, the user is solely responsible for all actions while using the equipment. Therefore, the following actions are prohibited:


1.     Any deliberate action, which damages or disrupts a computing system or network, alters its normal performance or causes malfunction, regardless of location or time duration. (trying to “crash” network systems or programs)


2.     Any willful development or introduction of computer “virus”, disruptive, or destructive programs into TLCC network.  NO DOWNLOADING WITHOUT PERMISSION!


3.     Deleting, copying, or modification of any files and/or data belonging to other users without their prior consent.


4.     Transmitting and/or processing files containing obscene, indecent, lewd material or other material, which explicitly or implicitly refer to sexual conduct.


5.     Transmitting any material in violation of any United States or state regulations.  This includes, but not limited to, copyright and threatening materials.


6.     Impeding other users through mass consumption of system resources.


7.     Using facilities and/or services for unauthorized commercial purposes.


8.     Forging or attempting to forge electronic mail messages.


9.     Attempting to read, delete, copy, modify, or view without permission, another user’s email.


10.  Sending or attempting to send harassing, obscene and/or threatening email to another user.


11.  Attempting to send unsolicited junk mail, “for profit” messages, or chain letters.


12.  Any other action that is deemed inappropriate.


 


TLCC of Shelby’s electronic network facilities are to be used exclusively for education, related functions, and applications. TLCC Directors will have access to all files, including email files. Users will have no expectation of privacy regarding the said files or email.  Any attempt to break the law with the network will result in litigation against the offender by the proper authorities. If such an event should occur, TLCC of Shelby will fully comply with the authorities to provide any information necessary for the litigation process. I understand and agree to abide by the terms and conditions of TLCC of Shelby Network Computing and Email Policy. I further understand that any violations of the above regulations are unethical and may constitute a criminal offense. I understand that any violation of these terms and conditions will result in the revocation of my access rights and the imposition of TLCC discipline. In addition TLCC of Shelby will comply with the authorities to provide any information necessary for the litigation process. As the parent/guardian of this student, I have read the Terms and Conditions for access to TLCC of Shelby Network Computing and Email Policy. I understand that this access is designed for educational purposes and TLCC has taken precautions to eliminate controversial materials. However, I also recognize that it is impossible for TLCC to restrict access to all controversial materials and I indemnify and hold harmless TLCC, its directors, officers, employees, volunteers, agents, and affiliates for materials acquired on the network. Further, I understand that the inappropriate use of network by my child will result in the revocation of my child’s access rights imposition of TLCC discipline. In addition, TLCC will comply with the authorities to provide any information necessary for the litigation process. I indemnify and hold harmless TLCC, its directors, officers, employees, volunteers, agents, and affiliates for supervision when my child’s use is not in a community center setting.  Further, I indemnify and hold harmless TLCC, its directors, officers, employees, volunteers, agents, and affiliates for any damages or injuries caused by my child’s use of the network, either in TLCC or outside of TLCC, in a manner which violates the Terms and Conditions set forth in this agreement. With this understanding, I hereby give permission to issue electronic access for my child and certify that the information on this form is correct. 

I have read and understand the Network Computing/Email Policy Contract.
(TLCC office will print to get your official signature in person at The Ladder.)

Signature:
Date:
Physical Activity Readiness Questionaire (PAR_Q)

If you're aged 15-69, the PAR-Q will tell you if you should check with your doctor before significantly changing your physical activity patterns.  If you're over 69 years and aren't used to being very active, check with your doctor.  Please read each question carefully and check yes or no.
 
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If you answered YES to one or more questions:  You should consult with your doctor to clarify that it's safe for you to become physically active at the current time.
If you answered NO to ALL of the questions:  It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.


Fitness Liability Release Form

I participate in the activity at my sole risk and responsibility.  I assume all risk and responsibility for any injury or property damage resulting from my participation in the activity.  Injury, medical treatment, or loss of work time required from an injury due to participation is the sole responsibility of the participant.


I state that I have completed the PAR-Q and am physically able to participate in any activity I choose and know of no medical or physical reason that participation could be potentially harmful in any way. I hereby affirm that I am in good physical condition and do not suffer from any disability which would prevent or limit my participation in any programs offered by The Ladder Community Center, putting my health at risk.


I release, indemnify, and hold harmless The Ladder Community Center, its personnel from and against any actions or claims which may be made by me or on my behalf in respect of, or arising out of any injury, loss, or damage caused to me or my property whether by my negligence or in any way whatsoever.


This release of liability includes all injuries which may occur upon the result of use of any exercise equipment, products, training and classes: the sudden, unforeseen malfunction of any equipment, instruction, or supervision.


I acknowledge I have carefully read the Fitness Liability Release Form and I fully understand therein its contents.  I agree to give up any right to bring legal action against The Ladder Community Center for negligence or any other personal injury, loss, or damage. I have read, understand, and fully agree with the Fitness Liability Release Form for The Ladder Community Center.

Date:  ____________________


Signature:__________________________________________


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Description

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