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11 Ogden City Golden Hours Senior Active Center Code of Conduct, Computer Lab Agreement, Disciplinary, Grievance and Appeal Procedures I acknowledge that I have read and fully understand the Golden Hours Center Code of Conduct, Disciplinary, Grievance and Appeal Procedures and agree to comply with all rules and procedures as stated. I understand that failure to abide by these eligibility requirements and rules for participation may result in corrective measures and/or restrictions, including suspension or revocation of my Center membership and the privileges of such. I do hereby release and forever discharge Ogden City, its agents, employees, volunteers and affiliates, from any and all actions, causes of actions, liabilities, claims or demands for or by reason of any damage, loss, or injury which may be sustained by me as a result of my participation in Center activities. NAME (print): ADDRESSS: CITY: STATE: ZIP: PHONE NUMBER: CELL PHONE: EMAIL DATE OF BIRTH: AGE: ISSUING GOVERNMENT IDENTIFICATION: IDENTIFICATION NUMBER: EXPIRATION: SIGNATURE OF MEMBER: DATE: Revised 10-21-16