Bigelow Center Membership

Membership is required to participate at the Bigelow Center. We welcome Fairfield residents and non-residents 50 years old and up. Membership is free for Fairfield residents and $25 per year for anyone out of town. To join, complete the membership form online (below) or in person at the Center. You can also download the PDF form here. Once submitted please pick up your membership card at the Center and you can then begin to register for classes/events. Payment for out-of-town members can be made at the Center with a check, cash or credit card. Renewal for annual membership is in July.

First Name*

Last Name*

Middle Initial

Address*

City*

State*

Zip Code*

Phone Number*

Email Address*

Date of Birth*

Marital Status

Name of Spouse

Emergency Contacts

Name Emergency Contact 1*

Phone Number Emergency Contact 1*

Relationship to Emergency Contact 1*

Second Emergency Contact:

Name of Emergency Contact 2

Phone Number Emergency Contact 2

Relationship to Emergency Contact 2

PARTICIPANT RELEASE AND WAIVER OF LIABILITY

To the fullest extent permitted by law, while attending or participating in programs or activities offered by the Town of Fairfield, Bigelow Center, or while in or on the premises where the program or activity is being conducted, I, for myself, my heirs, successors, executors, administrators and assigns, knowingly and voluntarily do hereby RELEASE, INDEMNIFY and HOLD HARMLESS the Town of Fairfield and the Bigelow Center, their officers, employees and agents from and against any and all liability, losses, claims, costs, damages, judgments, suits and expenses, including reasonable attorney’s fees, arising from, alleged to arise from, or resulting in personal injury or other damages to me, any third party, or my property, WHETHER CAUSED BY THE NEGLIGENCE OF THE TOWN OF FAIRFIELD, OR THE BIGELOW CENTER, OR OTHERWISE. I further RELEASE, INDEMNIFY, and HOLD HARMLESS the Town of Fairfield and the Bigelow Center, their officers, employees and agents from and against liability for any claims of injuries or other damages that I may cause to any person or property while attending or participating in programs or activities offered by the Town of Fairfield, Bigelow Center, or while in or on the premises where the program or activity is being conducted. I understand that if I am injured while attending or participating in any program or activity, or while in or on the premises where the program or activity is being conducted, I am solely responsible for any and all costs that I may cause or incur, including medical treatment.

I have read and understand the Participant Release and Waiver of Liability. DISCLAIMER: By checking this box and typing your name below, you are signing this membership form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.*

I Agree

Your Full Name*

The Bigelow Center for Senior Activities is dedicated to promoting a dignified, healthy quality of life for older adults by advocating for vital services, providing opportunities to develop meaningful fellowship, offering lifelong learning activities, recognizing the continued and varied accomplishments of older adults, and being an accessible and trusted community resource. Consistent with these goals, the Bigelow Center requires that all members and guests abide by the following rules of conduct and general facility rules. Failure to abide by these requirements may result in the individual violating the rule being asked to leave the Bigelow Center. Severe or pervasive offenses, as determined in the Bigelow Center’s sole discretion, may result in temporary or permanent exclusion from the Bigelow Center.

Member Code of Conduct

• Treat everyone with respect.
• The use of abusive, intimidating, lude, threatening, or harassing language, body language, or gestures is strictly prohibited.
• Fighting, physical abuse, challenging others to fight, destroying or damaging property and other disruptive, intimidating or harassing behaviors are strictly prohibited.
• Alcohol or illegal drugs shall not be brought to the Center or Center grounds. Anyone under the influence of alcohol or illegal drugs will be asked to leave the Center.
• Weapons of any kind are not permitted on the premises.
• The Center does not provide sleeping accommodations. Lying outstretched or sleeping on the furniture or the floor is not allowed.
• Proper shoes and clothing must be worn at all times.
• No solicitation or sales of goods or services by an individual, participant or group are allowed.
• Participants who cause an unreasonably loud noise that is disturbing or annoying may be asked to leave the building.
• Please refrain from any PDA (public display of affection) which includes but is not limited to: sexually implicit dancing, kissing, groping and lap sitting.
• All Town of Fairfield Facility Policies as set by the Fairfield Health Department and Town of Fairfield apply to the Bigelow Center. In times of health concerns, appropriate facemasks may be required and hands must be sanitized upon entry. Those who refuse will not be permitted to enter the building.

General Facility Rules

• Participants must complete and submit a registration form annually and scan card/sign-in at each visit.
• Participants are not allowed in staff areas (kitchen, offices, closets) without staff permission.
• Service Animals (as defined by federal and state law) may enter the Center, must be restrained, and under the supervision of their companion or owner at all times.
• Animals may not be left unattended outside the Center.
• Community phone use is limited to local calls for emergencies.
• Restrooms shall not be used for bathing, shaving, or washing clothes.
• Smoking is strictly prohibited in the building or on the premises.
• Personal belongings must not be left unattended.
• Any minor visiting the Center must be signed in and supervised by his/her guardian at all times. Minors who are volunteering must have parental approval under the supervision of designated staff, teacher or parent at all times.
• All senior center participants under 60 years of age who participate in the lunch program shall pay $13.00 per meal and wait until eligible seniors have been served.
• Surveys, photographs, or video recording in the Center require prior written permission of the staff. Release forms are required.

Agreement of Participant

I have read and agree to follow the Bigelow Center for Senior Activities Member Code of Conduct and General Facility Rules. DISCLAIMER: By checking this box and typing your name below, you are signing this membership form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.*

I Agree

Your Full Name*