ZAFIROVSKI SPORTS DOME AND MCCOMB POOL MEMBERSHIP
A membership entitles you to the use of the new Zafirovski Sports Dome Facility and/or our McComb Field House Pool,
depending on your selection. Our sports dome includes a six-lane oval running track for running and walking activities
along with several courts for playing basketball. Our pool facility includes a six-lane pool along with shower and locker
facilities. You may use our shower facilities along with storing your items in one of our lockers. We simply request that
your belongings be removed from the locker when you leave each time. Pad locks or combination locks are
recommended and must also be removed after each visit. All minors must be accompanied by a parent or guardian.
The facilities hours are currently as follows and subject to change without notice:
Sports Dome Hours
McComb Pool Hours
Fall and Spring semesters when classes are in session:
Fall and Spring semesters when classes are in session:
Monday - Friday: 12:00pm to 1:00pm
Monday , Wednesday, Friday: 12:00pm to 1:00pm
Sunday - Thursday: 9:30pm to 12am
Tuesday, Thursday: 11:30pm-12:30pm
Monday - Thursday: 8:30pm to 10:30pm
Sunday: 6pm to 9pm
No summer hours.
Summer when classes are in session:
Hours are posted outside of pool entrance.
Please complete and return the membership form, a signed informed consent release, and a signed Insurance and Physical
Activity Release, and a check made payable to Edinboro University. Membership cards will be mailed to the address you
list below and expire one year from the date the membership was processed.
A $25 permit is required to park on campus. Payment for the permit can be made at the Bursar Office in Hamilton
Hall. You must bring the receipt and pool pass to the University Police at 911 Scotland Road to obtain the permit.
Questions? Contact Denise Dobos at ddobos@edinboro.edu or (814) 732-1824.
Membership Form
Name ________________________________________________________________ Date ______________________
Cell Phone______________________________________ Home Phone ______________________________________
Address_______________________________________ City ________________________ State ______ Zip _______
Email ____________________________________________________ Year of Graduation (if Alumni) ___________
Membership Type: Please select one.
McComb Pool
McComb Pool – Edinboro University Alumni
Zafirovski Sports Dome
Zafirovski Sports Dome – Edinboro University Alumni
Zafirovski Sports Dome and McComb Pool
Zafirovski Sports Dome and McComb Pool – Alumni
Single
$60.00
$50.00
$60.00
$50.00
$100.00
$90.00
_____________
_____________
_____________
_____________
_____________
_____________
Family (up to 4 persons)
$130.00 _____________
$115.00 _____________
$130.00 _____________
$115.00 _____________
$240.00 _____________
$225.00 _____________
Names for Membership Cards:
1. ________________________________
2. _________________________________
3. ________________________________
4. _________________________________
Make check or money order payable to EDINBORO UNIVERSITY and send to:
Athletic Department ● Attn: Business Director for Athletics ● McComb Field House ● 455 Scotland Road ● Edinboro, PA 16444
INFORMED CONSENT RELEASE AND EXPRESS ASSUMPTION OF RISK
Open Pool and/or Dome Recreational Activities
Edinboro University
I realize injuries can be a consequence of participation in open pool and/or dome recreational
activities and no amount of reasonable supervision or use of the facility will prevent injury. I
appreciate the character of the risk involved, and I voluntarily assume all risk of possible death,
harm or injury. I understand and appreciate that open pool and/or dome recreational activities
and physical activity involving rigorous exertions and is inherently subject to a risk of substantial
physical injury and even death from some actions.
In accepting this risk, I expressly and explicitly release, discharge and waive any and all
responsibility of Edinboro University, Pennsylvania State System of Higher Education, the
Commonwealth of Pennsylvania, and the employees, officials or agents of any and all of the
foregoing, pursuant to, or pertaining or related to, or arising from, in any matter, injuries to me as
a result of my participation in this activity.
By my signature below, I certify that I completely understand this document.
Participant Printed Name
Participant/Guardian Signature
Date
Participant Printed Name
Participant/Guardian Signature
Date
Participant Printed Name
Participant/Guardian Signature
Date
Participant Printed Name
Participant/Guardian Signature
Date
Witness Signature
Date
WITNESS:
Witness Printed Name
INSURANCE AND PHYSICAL ACTIVITY RELEASE FORM
Open Pool and/or Dome Recreational Activities
I,
, have had a recent physical examination and am physically
able to participate in open pool and/or dome recreational activities. I know I am responsible
for my own medical expenses if I am injured during this activity.
In the event of illness or injury resulting or arising directly or indirectly out of said activity, I
hereby give my consent and authorization for (1) administration of emergency first aid care and
treatment at the scene of the emergency by faculty, staff members, or volunteers of the
UNIVERSITY or (2) the administration of any treatment deemed necessary by a licensed
physician or dentist and (3) the transfer to any hospital reasonably accessible. The authorization
is not intended to cover major surgery unless the medical opinions of two (2) licensed physicians
or dentists, concurring in the necessity for such surgery are obtained prior to the performance of
such surgery. I further declare and warrant that I am covered by sufficient medical and dental
insurance and that such insurance will remain in effect during my child’s participation in said
activity.
Participant Printed Name
Participant/Guardian Signature
Date
Participant Printed Name
Participant/Guardian Signature
Date
Participant Printed Name
Participant/Guardian Signature
Date
Participant Printed Name
Participant/Guardian Signature
Date
EMERGENCY CONTACT INFORMATION:
If there is an emergency, please contact:
Name
Relationship
Phone Number