Dolores Dore Eccles Health, Wellness and Athletic Center Membership Agreement

Please read the Terms and Conditions for the Dolores Dore Eccles Health, Wellness, and Athletic Center before filling out this form.

* indicates a required field.

       
* Today's Date (Month/Day/Year):  
* Name:  
  Age (if under 18):  
* Main Phone (including area code):  
  Alternate Phone (including area code):  
* Email Address:  
* Date of Birth:  

Emergency Contact Information

(Emergency contact information is specific for emergencies in the Dolores Dore Eccles Health, Wellness, and Athletic Center and is not campus wide.)
* Name:  
* Relationship:  
* Main Phone (including area code):  
  Alternate Phone (including area code):  

IMPORTANT

* I have read the membership agreement linked above and agree to its terms and conditions. I further agree to abide by all College, Department, and Health, Wellness and Athletic Center policies, rules and guidelines. I have read and agree.  
* By typing my name here, I agree to the terms and conditions (Parent/Guardian name if user is under the age of 18)