Covington Sportsplex Patron Application

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Please complete the questions below.

Email *

First and Last Name *

Address *

Phone Number *

Age

Birthday *

Emergency Contact Name *

Emergency Contact Phone Number *

Relation to Emergency Contact *

Type of Membership *

Single Membership

Family Membership

Special Needs Adult

Military Single

Military Family Membership

Teacher Single Membership

Teacher Family Membership

Fire/Police Single Membership (works outside of the City of Covington)

Fire/Police Family Membership (works outside of the City of Covington)

City Employee Single Membership

City Employee Family Membership

Senior Membership

Student Membership

Corporate Single Membership

Corporate Family Membership

Which amenities would you like for your membership to include? *

Covington Sportsplex

Covington Aquatic Center

Both

必填

Type of Membership *

Annual

Monthly

Are you a resident of Tipton County? *

Yes

Immediate Family to be Included in Membership

Eligible family members include a spouse and all dependent children under the age of 21 unless dependent is a full-time student that lives at home and is 23 years or younger. Patrons MUST be 14 years old to use the weight room. Patrons below the age of 16 years old MUST be accompanied by a parent AT ALL TIMES when utilizing the weight rooms. Patrons under the age of 12 MUST be accompanied by a PARENT when using the racquetball courts.

List all family members included in membership (if family membership)

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