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Boston Conservatory Student

Please be advised that all information is required; you will not be able to submit the form unless you fill it out completely.


Last Name: First Name:


Your Email: Phone #:


Address: City:

State: Zip:


Emergency Phone # : Contact Name:


Please select type of membership:


Have you previously had a gym membership to Northeastern University:


The Membership is non-transferable

Code of Conduct

- Participants do hereby agree to uphold Code of Conducts:

- Harassment or intimidation by words, gestures, body language or any other menacing behavior will not be tolerated.

- Participants exhibiting abusive behavior, either verbally or physically toward a patron or campus recreation employee will be asked to leave the
facility immediately. If the participant refuses to leave the facility, Northeastern University Public Safety will be called to remove the participant.

- Each participant is legally and financially responsible for any removal, defacing or willful damage to public or private property. This includes the property of fellow participants, staff and Northeastern University.

- The use, possession or concealment of any drugs, tobacco products, alcoholic beverages, weapons and firearms is forbidden.

- Proper work-out attire must be worn at all times. Food, beverages, gym bags, shopping bags, luggage, briefcases, backpacks, street shoes, boots, open-toe shoes, sandals, jeans, cargo pants and jackets are not allowed above the ground floor.

- Any individual acting in the fashion of a personal trainer must be hired through the Campus Recreation Office at 140 Marino Center. Personal training on the premises of any Northeastern recreation facility is restricted to Northeastern Personal Trainers only. Any individual found soliciting these types of services will be denied further access to these facilities.

Release and Hold Harmless Agreement

I, in consideration of Northeastern university allowing me to use its recreational facilities, hereby release and discharge Northeastern University, its trustees, employees, students and agents from liability, claims, demands and actions from or in any way related to my presence on University property or use at the recreational facilities except as such demand arises from the sole negligence or intentional acts of the University.

I further acknowledge that I understand and assume the risks inherent in exercise activities and that it is my sole responsibility to engage in exercise activities appropriate to my age, health and fitness level.


I hereby acknowledge and accept the above. (your initials will act as your electronic signature)