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Student Membership Form

Fall 2012 / Spring 2013

Membership Fees ARE NOT Refundable, Transferable or Pro-rated

Please fill out all the fields.


Name:

ID#:

Local Address:
ex. 120 Funnelle Hall
Gender: Male  Female

Phone:

E-mail:

Membership Fees and Categories: (update: only semester rates apply for spring semester)
  Semester Academic Year
Resident Student $60.00 $80.00
Off Campus students who previously lived
on campus at Oswego for:*		 ------------- -------------
6 or more full semesters $65.00 $90.00
4-5 semesters $70.00 $100.00
1-3 semesters $80.00 $110.00
---------------------------------------------- ------------- -------------
Commuter Students $90.00 $125.00
*Summer housing does not apply


Health History Information (check any that apply):

Diagnosed heart condition
Chest Pain with or without physical activity
Bone or joint problems that could be made worse by physical activity
Major surgeries in the past two years
Dizziness or loss of consciousness
Diabetes
Medications that affect physical activity
Any other reason why you should not participate in physical activity

Please explain any of those you have checked (if needed):

Please Note: If you have checked any of the above, it is strongly recommended that you consult your physician prior to engaging in any exercise program

IMPORTANT: Please read the following prior to submitting:

I understand that it is strongly recommended that every individual see a physician prior to starting an exercise program of any kind, and that a consultation with a physician is in my best interest, especially if I have not exercised within the last year and/or I am over 40 years of age. After reviewing my medical history information and/or discovering a medical condition that would contraindicate my participation in the fitness center program, it may be determined that I am not eligible for membership. In that event, I will be entitled to a prorated refund.

The Fitness Center Staff if responsible for enforcement of college policies and Fitness Center guidelines. Failure to adhere to these policies may result in the following:
1. Immediate removal from the centers by the staff and a required scheduled meeting with the Fitness Center Manager before returning to the centers.

2. Continual abuse of Fitness Center policies may result in revocation of membership with no refund and disciplinary review through the campus judicial system.

I agree that I will not hold Oswego State and/or the State of New York liable for any injuries that I may incur due to participating in a prescribed fitness program and/or using equipment or facilities at Cooper/Glimmerglass Fitness Centers.

I understand that I will be billed for the cost of the membership through the Office of Student Accounts.

I understand the above statements and agree to adhere to the Fitness Center Policies.




To utilize the Fitness Center immediately, please print out the form after you hit the submit button and present it to the front desk.

***Please allow 1-2 business days to process. Your 3 free guest passes can be picked up at at either Fitness Center.

If you have any questions or comments, please e-mail us at fitness@oswego.edu

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