Membership Application

Date of Application *

MM

DD

YYYY

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

Birth Date *

MM

DD

YYYY

Are you a veteran? *

Yes

No

Spouse (if couple membership)

First Name

Last Name

Spouse's Birth Date

MM

DD

YYYY

Phone Number *

(###)

###

####

Doctor Name *

First Name

Last Name

Phone Number *

(###)

###

####

Membership Type *

Monthly Fitness Membership

Basic Annual Individual Membership $60

Basic Annual Couple Membership $100

Winter Texan Individual Membership $40

Winter Texan Couple Membership $60

Monthly Fitness Membership $50

Liability Release *

By submitting this application, I assume any risk of harm or injury which might occur in any program at the Comal County Senior Center facilities and grounds. I release any and all of the volunteers, instructors, staff or representatives of the Comal County Senior Center from all liability, costs and damages which might arise from participation in any program. Should my photo be taken at any of the center activities, they have permission to use it for publicity purposes.