Applicant Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of Partner/Spouse

If applicable

First Name

Last Name

Partner/Spouse Birthday

MM

DD

YYYY

Child #1 Name *

First Name

Last Name

Child #1 Birthday *

MM

DD

YYYY

Child #2 Name

First Name

Last Name

Child #2 Birthday

MM

DD

YYYY

Member Agreement *

I understand that I (and/or my associate member, if applicable) will be volunteering 5 to 10 hours minimum per year (as a household/collectively) to help run SLFC. I also understand that only the member of my household with the “Full Member” status has the ability to vote and hold a board position within the club.

I Agree

Digital Signature for Liability Release* *

*All members must have liability release on file with the club before attending any activities or programs. I UNDERSTAND THAT MY PARTICIPATION AND THE PARTICIPATION OF ANY MEMBERS OF MY FAMILY IN ANY SLFC CLUB ACTIVITY OR PROGRAM IS COMPLETELY VOLUNTARY, AND WE HEREBY GIVE PERMISSION FOR ME AND MY FAMILY TO JOIN IN THOSE ACTIVITIES OR PROGRAMS. MY FAMILY SHALL HOLD HARMLESS THIS CLUB OR REPRESENTATIVES, PAID OR UNPAID, AND/OR THE PROVIDERS OF ANY ACTIVITY OR PROGRAM, LOCATION AND/OR MATERIALS FROM ANY LIABILITY AND/OR RESPONSIBILITY FOR ANY ACCIDENT, ILLNESS OR INJURY THAT OCCURS DURING OR AS A RESULT OF ANY FUNCTION OR PROGRAM. I ACCEPT THAT THE FINAL RESPONSIBILITY FOR MY SAFETY AND THAT OF MY FAMILY RESTS WITH ME.

First Name

Last Name

Date *

MM

DD

YYYY