Form Center

2. Youth Fitness Policy

   Ages 11-13

   May utilize the Fitness Floor and Upstairs Fitness Area Friday, Saturday, and Sunday ONLY and must be actively supervised by a parent/guardian.

   Ages 14-17

   May utilize the Fitness Floor and Upstairs Fitness Area during facility operating hours.

4. Today's Date*
   Today's Date
6. Child's Last Name*
7. Child's First Name*
9. Child's Birthdate*
   Child's Birthdate
10. Child's Age*
12. Emergency Contact Name*
14. Emergency Contact Phone Number*

16. Fitness Center Rules and Regulations (PDF)

18. Authorization

    My child has my permission to use the Vandalia Recreation Fitness Center. Abuse of the facilities, policies, and procedures may result in the revocation of use of the facility and the privileges it provides. By signing this form, I am stating that my child is fit and able to participate in this activity. In consideration of participation in this activity, I hereby indemnify and hold harmless the City of Vandalia, its agents and employees, from all liability for any injury or health problems suffered by my child arising from or connected with this activity and assume all risk for any injury. 

    This form shall be considered valid until changed in writing by the undersigned parent/guardian and received by the Vandalia Parks and Recreation Department.

    By signing my electronic signature I acknowledge that my child and I have read, fully understand, and agree to the Fitness Center Rules and Regulations (PDF).

20. Electronic Signature*
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field