NUTRITION SITE ONLY


AUTHORIZATION

Please read and initial each rule below, indicating you understand what’s stated:

I understand that I have to be 60 years of age or older to participate in the meal program and that the date of birth entered above is correct to the best of my knowledge.


I understand that the center/site has a grievance procedure posted that will tell me how to lodge a complaint in the event that I feel I am being discriminated against due to my race, creed, color, sex, age or national origin.


By signing below I agree that I have read and received a copy of the policy and procedures manual and the information I have provided on this forms is true and correct.


Liability Waver

I, the undersigned, understand and expressly assume the risk involved in participating in any form of exercise and/or any physical activity or use of exercise equipment at the Jonesborough Area Senior Center, or any other sites utilized by the same agency.  I hereby agree to indemnify, save and hold harmless the Jonesborough Area Senior Center, the Town of Jonesborough and/or any agency, individual who volunteers or contracts with the center, to coordinate these activities, for my health, safety, loss of property and injury resulting from my participation in outdoor and/or indoor activities of the Jonesborough Area Center.


To the best of my knowledge, I have no physical restrictions which would prohibit my participating in physical activities. The Jonesborough Area Senior Center, and/or any volunteer representing the senior center have my permission to have emergency medical personnel attend me during my participation of activities at the center, if deemed necessary.


I, the undersigned, grant the Jonesborough Area Senior Center the right to use any still or motion pictures of me during center activities.


We appreciate the contribution of our Volunteers!!  Our senior community benefits greatly when you share your gifts and talents.  We will follow up with you or feel free to contact our Volunteer Coordination at 423.753.4852 for more information. 


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