WAYNE COMMUNITY CENTER MEMBERSHIP APPLICATION

Parks & Recreation
1 Pike Dr.
Wayne, New Jersey 07470
www.waynetownship.com
Phone: 973-694-1800
Fax: 973-694-9100

Full Name

Date of Birth

Address

Phone No.

Email

If Membership includes more than one individual, add them here:

Name of Family Member

Date of Birth

Relationship to Applicant

Grade (if child)

Add More

Name of Family Member

Date of Birth

Relationship to Applicant

Grade (if child)

Add More

Name of Family Member

Date of Birth

Relationship to Applicant

Grade (if child)

Add More

Name of Family Member

Date of Birth

Relationship to Applicant

Grade (if child)

Add More

Name of Family Member

Date of Birth

Relationship to Applicant

Grade (if child)

Add More

Name of Family Member

Date of Birth

Grade (if child)

Emergency Contact Name

Emergency Contact Phone No.

Standard membership

INCLUDES ACCESS TO THE FITNESS CENTER*, INDOOR POOL, SQUASH COURTS, LOCKERS ROOMS AND OPEN GYM. PERFECT FOR THOSE WHO JUST WANT TO GET IN A GOOD WORKOUT!

STANDARD MEMBERSHIP	RESIDENT MONTHLY	RESIDENT ANNUAL	NON-RESIDENT MONTHLY	NON-RESIDENT ANNUAL
YOUTH (2-13)	$10	$110	$15	$165
STUDENT (14-17)	$25	$275	$30	$330
ADULT (18-61)	$39	$429	$59	$649
SENIOR (62+)	$29	$319	$44	$484
FAMILY	$79	$869	$109	$1,199

Premium membership

ENJOY ACCESS TO THE FITNESS CENTER*, INDOOR POOL, LOCKERS ROOMS, SQUASH COURTS AND OPEN GYM. PREMIUM MEMBERSHIP ALSO INCLUDES MOST ADULT EXERCISE CLASSES, AND SOME YOUTH EXERCISE CLASSES AT NO ADDITIONAL COST! PREMIUM MEMBERSHIP INLCUDES DISCOUNTED RATES ON YOUTH & ADULT PROGRAMS.

PREMIUM MEMBERSHIP	RESIDENT MONTHLY	RESIDENT ANNUAL**	NON-RESIDENT MONTHLY	NON-RESIDENT ANNUAL**
YOUTH (2-13)	$25	$275	$30	$330
STUDENT (14-17)	$40	$440	$45	$495
ADULT (18-61)	$59	$649	$79	$869
SENIOR (62+)	$49	$539	$64	$704
FAMILY	$99	$1,089	$129	$1,419

¨ The fitness center does not permit children under the age of 12.
Children 12-14 must be accompanied by an adult.

¨ ** Premium FAMILY annual membership also includes the following:
(2) personal training session at no cost, per year, per family

Membership Category

Youth

Student

Adult

Senior

Family

Membership Type

Standard Membership

Premium Membership

I would like to be billed...

Monthly (Automatic draft payment)

Annually

I certify that all persons stated on this membership application are members of my household and are my legal dependents. I certify that all information on this application is correct and accurate. I understand Wayne Township reserves the right to request verification and to terminate membership if information proves to be false.

Family membership includes up to two adults who are married, domestic partners or civil union partners, and their unmarried children 22 years of age and younger, residing in the same household. Any other individual living in the same residence must register separately.

I understand that any member ages 12-15 will not be permitted to use the Fitness Center or Strength Room without a legal guardian age 18 or older present. Children under the age of 12 will not be permitted to use the Fitness Center or Strength Room at any time. All children under the age of 15 must have a legal guardian, age 18 or older present to use the swimming pool. All children 13 and under are required to remain with a legal guardian, age 18 or older, at all times. If a child is found inside the facility without a legal guardian, every effort will be made to contact the child’s guardian(s). If all attempts fail, the Wayne Police will be contacted to take custody of the child.

I certify that I have been provided a copy of the facility rules and regulations and agree to abide by these terms and conditions.

Signature

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Wayne Community Center Membership Application