Kilkich Fitness Room Users Agreement / Covid-19 Safety Waiver Survey

Question Title

* 1. I am a...(please check the box of all that are applicable)

Member of the Coquille Indian Tribe or Spouse of a Tribal member

Employee of the Coquille Indian Tribe or Coquille Tribal Business

Kilkich Resident

Patient of the Ko-Kwel Wellness Center

A guest of one of the above, only using the KFR in company of a member.

Question Title

* 2. Check each box to acknowledge you have read the following KFR Rules:

KFR is only for Tribal members, employees of the Coquille Indian Tribe or Coquille Tribal Businesses, Kilkich residents, and patients of the Ko-Kwel Wellness Center who are ages 18 and above

Minors, age 13-17, may use KFR with parental supervision only. Be aware that fitness equipment and machines can be potentially dangerous. Please monitor minors at all times.

Children 12 and under may NOT use the Kilkich Fitness Room

KFR members may bring guests to work out with them as long as the guest only uses the KFR in company with the member.

Any member or guest using KFR must have a completed and signed User Agreement Form/Covid-19 Safety Waiver completed before they can access the facility

A KFR member MAY NOT share the KFR entrance code with any other member or guest.

The Coquille Indian Tribe is not responsible for lost, stolen, or damaged personal items.

KFR users are asked to clean up after themselves. Replace all weights, ropes and other equipment neatly within the holding area. Report housekeeping concerns to the Ko-Kwel Wellness Center Executive Secretary.

Do not use any damaged equipment. Please report damage to Ko-Kwel Wellness Center Executive Secretary.

Equipment must be used as intended. Misuse of equipment or property will be grounds for exclusion from the fitness room.

Music and television volume must not be excessive.

No pets are allowed inside the facility.

General parking for KFR is the concrete apron west (down the hill) of unit A.

The concrete apron directly in front of KFR (Unit A) is reserved for Elders and individuals with disabilities

KFR area is camera monitored.

Hours of operation: 24 hours a day 7 days per week.

Question Title

* 3. Check each box acknowledge Release of Liability and Indemnity:

I am using this facility for my own benefit and I agree to the rules initialed above.

I agree to hold harmless, release and indemnify Coquille Indian Tribe and their agents, officers, and employees for any bodily injury suffered by me or minors in my care while accessing or utilizing the Kilkitch Fitness Room.

I understand that I will use the equipment at my own risk.

I further understand that any violations of the rules could result in the forfeiture of privileges.

I certify that I have been declared physically able by a health care provider to use the equipment provided.

Kilkich Fitness Room Users Agreement / Covid-19 Safety Waiver

Part I - USERS AGREEMENT

Question Title

* 1. I am a...(please check the box of all that are applicable)

Question Title

* 2. Check each box to acknowledge you have read the following KFR Rules:

Question Title

* 3. Check each box acknowledge Release of Liability and Indemnity: