___High Blood Pressure ___Chest Pain ___Orthopedic Conditions ___Stroke ___Heart Disease ___Heart Attack ___Dizziness/Vertigo ___Osteoporosis ___Hypoglycemia ___Diabetes ___Heart Murmur ___Hernia ___Anemia ___High Cholesterol ___Shortness of Breath ___Arthritis ___Cancer ___Irregular Heart Rate ___Respiratory Disease ___Thyroid Disorder ___Blood Disorder ___Epilepsy or Convulsions ___Gastrointestinal Disorder ___Depression ___Pacemaker ___Electrical Implant ___High Stress ___ Abnormal Heart Rhythm ___Varicose Veins ___Lung Disease ___Rheumatic ___Insomnia ___Loss of Consciousness
As a 24-hour secure-access fitness facility, Fit Physique LLC (hereafter referred to as "the gym"), has a few different policies and procedures than a typical fitness facility. Please read the information carefully. If you have any questions, please ask. Acknowledgement of Risk and Waiver of Liability I voluntarily assume the risk of injury, accident, death, loss, cost or damage to my person or property which might arise from my use of the gym, and I agree to hold harmless and release the gym and all affiliated corporations, and its officers, directors, board members, agents, employees, representatives, executors, and all others from any and all liability. I also release all of those mentioned and any others acting on their behalf from any responsibility or liability for any injury or damage to myself including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities or the use of any equipment at the gym during staffed or non-staffed hours. General Statement of Program Objectives and Procedures I understand that a physical fitness program may include exercises to build the cardiorespiratory system (heart and lungs), the musculoskeletal system (muscle endurance, strength and flexibility), and to improve body composition (decrease of body fat in individuals needing to lose fat, with an increase in muscle and bone). Exercise may include aerobic activities (treadmill walking/running, bicycle riding, rowing machine exercise, group aerobic activity, swimming, and other such activities), calisthenics, and weight lifting to improve muscular strength and endurance, and flexibility exercises to improve joint range of motion. Description of Potential Risks I understand that the reaction of the heart, lung, and blood vessel system to such exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or during exercise, which may include abnormalities of blood pressure or heart rate, in effect of functioning of the heart, and in rare instances heart attacks. Use of the weight lifting equipment, and engaging in heavy body calisthenics, can lead to musculoskeletal strains, pain, and injury if adequate warm-up, gradual progression, and safety procedures are not followed. (PAR-Q) Physical Activity Readiness Questionnaire Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Becoming more active is very safe for most people. However, some people should check with their Doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, this questionnaire (the PARQ) will tell you if you should check with your Doctor before you start. If you are over 69 years of age and you are not used to being active, check with your Doctor. Cleared for Exercise I certify that I am in good physical health and I am able to undertake and engage in the range of physical activities in which I choose to participate at the gym. I assume all responsibility for updating the facility with respect to any changes in my physical or mental condition and for reporting all injuries sustained at the facility to the gym staff. I understand and am aware that strength, flexibility, aerobic and anaerobic exercise, including the use of any equipment, is a potentially hazardous activity. I also understand that fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities and using equipment with knowledge of all the dangers involved. I do hereby agree to expressly assume and accept any and all risks of injury or death either accidental or otherwise. This waiver, release and indemnification agreement includes, without limitation, all injuries which may occur as a result of (a) my use of all amenities and equipment in the facility and my participation in any class, activity or personal training, (b) sudden unforeseen malfunctioning of any equipment and (c) my slipping or falling while in the facility, on the facility premises, including adjacent sidewalks and parking areas. I acknowledge that I have carefully read this waiver, release and indemnification agreement and fully understand that it is a full and complete release of all liability. Duty to Inform of Changes in Health Condition I understand that I am required to inform the gym of any material changes in my health condition in the future, including but not limited to, any changes which would cause me to change my responses to the PARQ above. General This contract represents the complete understanding between you and the gym. No representations, written or oral, other than those contained in this contract are authorized or binding upon the gym. Should any part of this agreement due to legal or other regulatory changes become unenforceable, the remaining provisions within this agreement not impacted by such change shall remain in full force as originally written. You agree to promptly update the gym of any changes of address, phone, e-mail address and/or bank account/credit card information. Other No use of tanning beds, spa area, personal training room, or back room during non-staffed hours. Unauthorized areas are clearly marked and secured with motion sensors and cameras during non-staffed hours. Please do not access these areas.
As additional consideration for allowing both my participation in an exercise training program or instruction and use of its facilities, I agree to the following Waiver and Release: I acknowledge that participation in an any exercise training program, including but not limited to weight lifting, running, jumping, balance, nutrition counseling, and sports performance training has certain inherent risks, hazards, and dangers which cannot be completely eliminated despite all safety precautions, including the potential for severe injury, paralysis, or death. I AM VOLUNTARILY PARTICIPATING IN AN EXERCISE TRAINING PROGRAM(S) AND INSTRUCTION WITH FULL KNOWLEDGE OF THE INHERENT RISKS, HAZARDS, AND DANGERS INVOLVED AND HEREBY ASSUME AND ACCEPT ANY AND ALL RISKS OF INJRY OR DEATH. I, for myself, my heirs, successors, executors, and assigns, hereby KNOWINGLY AND INTENTIONALLY WAIVE, RELEASE, AND HOLD HARMLESS its members, directors, officers, agents, employees, instructors, coaches and volunteers from and against any and all claims, actions, causes of action, liabilities, suits, expenses (including reasonable attorney’s fees) arising directly or indirectly from my participation in any exercise training program or instruction or arising while I am under the instruction, supervision, and/or control of any of the released parties, regardless of whether the damage, loss, injury, paralysis, or death results from negligence of any released party or from some other cause.
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Student and Family Memberships must be completed in-person.
EFT Request and Authorization: Client hereby authorizes Fit Physique LLC or its assigns to make periodic charges or withdrawals (“EFT Authorization”) from the account used to pay the initial payment described above or the account listed below or replacement account designated by Client and accepted by Fit Physique LLC for payment of any and all fees, late charges, costs, expenses, or any other monies (see “Weight & Cardio Room Rules and Guidelines to Follow” page) due to Fit Physique LLC under the terms and conditions of this Agreement. Client understands that Client is entitled to notice of all varying charges and withdrawals under the EFT, but Client waives the right to receive prior notice for charges or withdrawals made with respect to any uncollected payments or portions of the balance due described above and the corresponding service charges, both of which Client agrees are not varying charges or withdrawals. Client may timely notify the financial institution in control of Client’s account to terminate this Request, but such notification will constitute a default and may cause all sums under this Agreement to be due and payable immediately together with all costs of collection to extent permitted by law. Fit Physique LLC or its assigns reserves the right to add the following fees to the Client’s account balance should any of the following occur.
TO QUALIFY FOR CANCELLATION By Fulfilling the Contractual Obligation – You may cancel a membership once the entire contractual obligation has been met by requesting a cancellation in writing only by completing a cancellation request form at the gym. Please note, due to needing an original signature our company does not accept faxes or emails. Pro rates are not full payments and are not counted as so. Per the contract the account must be current in order to submit a cancellation request. Also, our billing service requires a 7 day notice and that the last payment be paid at the time of the request. The 7 days is not prorated but means you must make a full payment if one falls within 7 days of when the request was made or received.
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By entering my full name above I am agreeing to/electronically signing to the terms discussed above.
By entering my full name above I am agreeing to/electronically signing to the terms discussed above.