VUKA MEMBERSHIP CONTRACT

MONTH-TO-MONTH CONTRACT

Vuka Fitness MEMBER REGISTRATION
Congratulations on your decision on joining the cool kids, just kidding.. not kidding! ALSO... Congratulations on your decision to get healthy and fit.
We are progressive and dedicated to bringing the latest and freshest challenges to motivate you on your journey.
HOW DID YOU HEAR ABOUT VUKA FITNESS?

This helps us with marketing :)
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FACEBOOK FRIEND GOOGLE INSTAGRAM
PERSONAL DETAILS

We want to know all about you!!
Name *

First Name Last Name
ID NUMBER: *
Mobile Number *
EMAIL: *
example@example.com
I, The undersigned, declare that all details provided are true and correct. I understand that training is at my own risk and that the affiliated trainers and companies and all private and public locations cannot be held responsible for loss of damage to personal being, items or injury.
I acknowledge that I have had a physical examination and have been given doctors permission to participate in the exercise program, or that I have decided to participate without prior doctors consent. I acknowledge that the trainer is not a physician and is not trained to provide medical diagnosis. I am aware that if I feel pain out of the ordinary in any way, either related to my training or otherwise, I should consult a physician.
I acknowledge that the coach will occasionally take photos and video footage for the website, or to document progress, and I hereby give her permission to do so. (Please delete this clause and initial alongside if you are in disagreement.)
I understand and am aware that strength and flexibility and aerobic exercise, including the use of equipment are potentially hazardous activities. I also understand that fitness activities incur injury or death, and that I am voluntarily participating in the activities and using equipment with knowledge of risk.
I hereby agree to expressly assume and accept any and all risks of injury or death. I here and forever release and discharge the trainer from any and all claims, demands, damages, and rights of action or causes of action, present or future.

I am responsible for payment of my account, and any attorney and client costs involved in recovery thereof.

By signing in below I acknowledge that I am physically and medically fit to participate with the normal routine of exercise. I acknowledge that the Trainers, will not be held responsible for any injury or loss suffered by me whether through negligence and/or omissions on the part of the coach or for any reason whatsoever. The Information given below is private and is used solely for future communication.
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I AGREE TO TERMS OF SERVICE

TERMS & CONDITIONS

JUST THE BASIC, STANDARD T's & C's, (#4 is most NB)
* Once off Joining Fee of R450 is Payable on completion of this form

In order to see improvements towards your health, fitness, and or performance goals, it’s imperative for you to follow programming protocols both during supervised and (if applicable) unsupervised training days. While working with us, every effort will be made to ensure your safety; however, as with any exercise/activity program, there are inherent risks. These risks include, but are not limited to, increased heart stress and chances of musculoskeletal injuries. In signing up for this program, you agree to assume responsibility for the mentioned inherent risks and waive any possibility for personal damage.

A Medical Release form is mandatory for participants with any exercise/ physical restrictions. Personal training participants who do NOT have a prior medical examination MUST acknowledge that they have been informed of its importance. By signing below, you accept full responsibility for your own health and well-being.

1. NO SHOW: clients that fail to show for their scheduled appointments will forfeit that session. Trainers that fail to show, will owe the clients one session for the missed appointment.
2. Your paid contract is to be used by you and are not transferable to any other person.
3. No refunds will be issued for any reason, including but not limited to relocation, illness and unused sessions.
4. Monthly contracts commence on the 1st of each month. 1 Month cancellation notice is required.
5. Classes may not be rescheduled for any reason, including but not limited to holidays and illness.

PERSONAL TRAINER / CLIENT CODE OF CONDUCT
1. Personal Trainers shall be committed to providing information that is consistent within the requirements and the limitations of their professional and credentialing association.
2. Personal Trainers shall preserve the confidentiality of privileged information, and shall not release such information to a third party unless the client consents to such release or release is permitted or required by law.
3. Personal Trainers shall not misrepresent in any manner, either directly or indirectly, their skills, training, professional credentials, identity or services.
4. Personal Trainers shall provide only those services for which they are qualified to give with their level of education and/or experience and by pertinent legal regulatory process.
5. Personal Trainers shall not engage in any form of conduct that constitutes a conflict of interest or that adversely reflects on the profession.
6. Personal Trainers shall not place financial gain above the welfare of the Client being trained and shall not participate in any arrangement that exploits the clients.
7. Personal Trainers shall never discriminate against any client based on race, creed, national origin, gender, religion, age, handicap/disability, sexual orientation or any other such legal classifications.
8. Personal Trainer and client shall maintain a direct means of communicating to allow for prompt, precise, and punctual service.

* No refunds will be issued for any reason, including but not limited to relocation, illness, natural causes, and unused sessions.
EMPLOYER/STUDENT NUMBER:
NAME OF MEDICAL AID:
PLAN/SCHEME/NUMBER
EMERGENCY CONTACT *
GP & CONTACT:
CONTRACT START DATE *

Month Day Year
Date
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I AGREE TO TERMS OF SERVICE

PHYSICAL ACTIVITY READINESS WAVIER

Let's make sure your body is up for the challenge!
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? *
Do you feel pain in your chest when you perform physical activity? *
In the past month, have you had chest pain when you were not performing any physical activity? *
Do you lose your balance because of dizziness or do you ever lose consciousness? *
Are you currently taking any medication? *
Do you know of any other reason why you should not engage in physical activity? *
Have you ever had any pain or injuries (ankle, knee, hip, back, shoulder, etc.)? *
Have you had any surgeries in the past 12 months? *
Has a medical doctor ever diagnosed you with a chronic disease, such as coronary heart disease, coronary artery disease, hypertension (high blood pressure), high cholesterol or diabetes? *
If you answered Yes to one or more questions , please explain:
What is your current occupation? *
Yes to one or more questions: It is strongly recommended that you have a Medical Clearance BEFORE you become significantly more physically active.

No to all questions: If you answered NO honestly to all questions you can be reasonably sure that you can become more physically active and take part in a fitness training program.
Note: If your health changes so that you then answer YES to any of the above questions, tell your fitness instructor, and ask whether you should change your physical activity plan.
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I AGREE TO TERMS OF SERVICE, I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.
Signature *

Clear

HANG IN THERE

Just a few more steps & you'll officially be one of us!!

COVID-19 Liability Release Waiver

In consideration of my participation in the foregoing, the undersigned acknowledge and agree to the following:
- I am aware of the existence of the risk on my physical appearance to the venue and my participation to the activity of the Organization that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
- I have not experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.
- I have not, nor any member(s) of my household, traveled by sea or by air, internationally within the past 30 days.
- I have not been, nor any member(s) of my household, diagnosed to be infected of COVID-19 virus within the last 30 days.
- I will notify the Organisation if I experience any flu like symptoms and will not attend any sessions for at least 14 days .
Following the pronouncements above I hereby declare the following:
- I am fully and personally responsible for my own safety and actions while and during my participation and I recognize that I may be in any case at risk of contracting COVID-19.
- With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its affiliates and employees, from any and all liabilities, claims, demands, actions, and causes of action whatsoever, directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
- I agree to indemnify, defend, and hold harmless the Organization from and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.
- By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.
  
  This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.
Signature *

Clear

DEBIT ORDER FORM

*COMPULSORY FOR GROUP FITNESS MEMBERS ONLY
VUKA FITNESS (PTY) LTD | 101 ROBERTS ROAD, HYDE PARK, SHOP 5, PIETERMARITZBURG REG 2018/064414/07
Authority and Mandate for payments Instruction:

Electronic and Written Mandates Given By:
Name of Account Holder *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
BANK DETAILS
BANK ACCOUNT NUMBER *
BANK NAME *
DEBIT AMOUNT *
TYPE OF ACC *
Abbreviated Name as Registered with the Bank  VUKA FITN

This signed Authority and Mandate refers to our contract dated (“the Agreement”).
I/We hereby authorise you to issue and deliver payment instructions to your Banker for collection against my/our above-mentioned account at my/our above-mentioned Bank (or any other bank or branch to which I/we may transfer my/our account) on condition that the sum of such payment instructions will never exceed my/our obligations as agreed to in the Agreement and commencing on   Date  . and continuing until this Authority and Mandate is terminated by me/us by giving you notice in writing of not less than 20 ordinary working days, and sent by prepaid registered post or delivered to your address as indicated above.

The individual payment instructions so authorised to be issued must be issued and delivered as follows: monthly.

In the event that the payment day falls on a Sunday, or recognised South African public holiday, the payment day will automatically be the preceding ordinary business day.

Payment Instructions due in December may be debited against my account on    Date   .

I / We understand that the withdrawals hereby authorized will be processed through a computerized system provided by the South African Banks and I also understand that details of each withdrawal will be printed on my bank statement. Each transaction will contain a number, which must be included in the said payment instruction and if provided to you should enable you to identify the Agreement. A payment reference is added to this form before the issuing of any payment instruction.

Mandate
I/We acknowledge that all payment instructions issued by you shall be treated by my/our above-mentioned Bank as if the instructions have been issued by me/us personally.

Cancellation
I/We agree that although this Authority and Mandate may be cancelled by me/us, such cancellation will not cancel the Agreement. I/We shall not be entitled to any refund of amounts which you have withdrawn while this Authority was in force, if such amounts were legally owing to you.

Assignment
I/We acknowledge that this Authority may be ceded or assigned to a third party if the Agreement is also ceded or assigned to that third party, but in the absence of such assignment of the Agreement, this Authority and Mandate cannot be assigned to any third party.

Signed at: PMB                         on this day: Date
Signature *

Clear
Should be Empty:

MONTH-TO-MONTH CONTRACT

HOW DID YOU HEAR ABOUT VUKA FITNESS?

PERSONAL DETAILS

TERMS & CONDITIONS

PHYSICAL ACTIVITY READINESS WAVIER

HANG IN THERE

DEBIT ORDER FORM

BANK DETAILS