Social Club Membership Upon completion of the following membership form, you will be prompted to pay the $60 membership fee. Member Name* First Last Parent/Guardian Name* First Last Member Date of Birth* Date Format: MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Emergency Contact 1* First Last Authorized to be called in the event of emergency. Is also permitted to drop off or pick up member.Emergency Contact 1 Phone*Emergency Contact 2* First Last Authorized to be called in the event of emergency. Is also permitted to drop off or pick up member.Emergency Contact 2 Phone*Shirt Size*SmallMediumLargeExtra LargeDouble Extra LargeTriple Extra LargeQuadruple Extra LargeRelease of Liability [Please Sign In Box Using Your Mouse]*In consideration of the undersigned individual’s participation in the above program and to the extent allowed by law, we hereby consent for said person to participate in the Wings- A Special Needs Community program known as Social Club and hereby release said organization, and all of its officers, employees, paid staff, and volunteers, from any and all liability or any kind of character arising out of said individual’s participation in such program and its activities, or any accident, illness or injury resulting therefrom, and agree to indemnify and hold harmless the organization and its officers, employees, paid staff and volunteers from and against any and all such claims, if any. I/We further consent for any adult leader of said activity to secure emergency medical treatment for the below named individual, which may be considered to be necessary in a situation in accordance with generally accepted standards with medical practices for the particular type of injury or illness involved. Also, by signing this release you understand that Wings utilizes photography and videography at Social Club events, and your member may be used in photo and/or marketing materials. This Release and Authority shall be valid and binding for the activity in which said individual participates unless previously revoked in writing.