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JENKS SENIOR CITIZEN NEW MEMBER APPLICATION FORM

  1. Jenks City Seal

  2. City of Jenks
    PO Box 2007
    211 N Elm St Jenks, OK 74037
    918-299-1700

  3. In consideration of the City of Jenks, Jenks Public Works Authority, and/or Jenks Aquarium Authority allowing me, and/or the below listed organizations' access to property owned by any or all of the above listed entities, I do hereby for myself, my heirs and assigns, or as authorized on behalf of my organization, as specified below, AGREE to release and hold the City of Jenks, Jenks Public Works Authority, and/or Jenks Aquarium Authority, its officers or employees harmless for any and all claims which I may have now or in the future resulting from access to City property, the condition of the City property and entry upon City property. I understand that I, and/or the organization listed below, assume all risks in association with the access to City property.
    Representing the following organization(s)
    City of Jenks
    Jenks Senior Citizens, Inc.

  4. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  5. Rev. 01/09/19

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