Badge Access Card Form

"*" indicates required fields

Access Card Information

Employee ID*

Name

First Name: Last Name:

Department & Job Title*

Department: Job Title

Number of days you plan to be in the office each week:*

Email Address:*

Choose a Status:*

Contractor

Temporary

Employee

Building Location:

CC1 – 2300 Yorkmont Rd

CC2 – 2400 Yorkmont Rd

COLAB/Lakepointe

Floor assignment:*

Cost Center:

Managers Information:*

Managers Name: Access Level:

Upon receipt of your security card make sure all the information is correct and sign below:*

Signature: Date:

THERE IS A FEE OF $15 IF YOUR CARD IS LOST AND MUST BE REPLACED

Fitness, Pickleball & Basketball Disclaimer:

Use of any and all equipment in the Fitness Center located on ONE / TWO (circle one) Coliseum Centre; AND use of the Pickleball court/Basketball court area, equipment and participation of pickleball or basketball court activities, is at user’s sole risk and responsibility. Landlord is not responsible for any loss or damage which may occur by or through the use of any equipment located in the fitness center and the pickleball court/basketball area, or through acts or omission of any individual using the fitness center and the pickleball court/basketball area; nor does Landlord, either express or implied, warrant the condition or operations of the equipment in the fitness room and the pickleball court/basketball area and its equipment. The equipment located in this facility is a convenience for the tenants only. *************************************************************************************IF YOU WANT ACCESS PLEASE SIGN BELOW*********************************************************************************************** I have read the above disclaimer and agree that the use of the fitness center and its equipment AND the use of the pickleball court/basketball area, equipment and activities, is at my own risk and that The RMR Group LLC will not be held liable for any loss, damage or injury resulting from my use of the fitness center AND the pickleball court/basketball area.

Signature Information:*

Signature: Date: Card Number:

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