Check √ one:              OCS District Resident                Non-Resident

                                                                                                                                         

 Member:                                                                     Date of Birth:                               

 Address:                                                                                                                          

 Phone: Home (    )                                                  Cell (     )                                          

 E-Mail Address:                                                                                                             

 Emergency Contact:                                              Phone            Relationship               

 Medical Concerns                                                                                                           

                (List any medical concern necessary to provide medical attention in case of an emergency)

 Walking Track Membership Only                        

 Fitness Center Fee Structure 2011-12 School Year

            $40.00 – Single Membership                                                                        

            $60.00 – Couples Membership                                                                     

            $75.00 – Family Membership                                                                       

Fitness center and walking track hours of operation and class offerings will be
 posted on the school website www.onekama.k12.mi.us

                                                                                                                                  

Signature (Student)                          Printed Name                              Date

                                                                                                                                 

Signature (Adult)                            Printed Name                               Date

 H:\Building Use Committee\2011-12 Membership Renewal Form.doc