Memorial Hospital FOCUS Fitness Gym Application Form

All members under family membership must reside in the same household. A Family Membership may include up to two (2) adults, as well as dependent children aged twelve (12) and older.

Children aged five (5) and older may be included under a Family Membership or a Class-Only Membership solely for the purpose of participating in group fitness classes and must be under the direct supervision of an adult listed on the membership during such classes.

After completing this form online, you will receive a call from the staff at FOCUS Fitness to arrange payment and schedule a tour if desired.

Membership types include: (All monthly memberships include processing fees)

• Single (Ages 14+) $320/Yearly or $35/Monthly
• Family (Ages 12-64 Limit of 2 adults + children in same household) $440/Yearly or $45/Monthly
• Senior (Age 65+) $250/Yearly or $25/Monthly
• Class Only Membership (For non-members to take classes and use the facility during class time) $50/Yearly *All Individuals over 18 years of age must have their own membership.
• One-Time Class Trial: Interested in dropping in for a class while you're visiting, or want to experience what our classes are all about? Our One-Time Class Trial lets you attend a class with a signed waiver—no membership required. It's a great way to explore your options before choosing a Class-Only Membership or a Full Access Membership.
• One-Week Membership: $20. In town for just a few days or want to try out the gym before committing? Our One-Week Membership is the perfect option. It includes full door access for seven days—no long-term commitment required.
• First Responder Discount (Must show badge or first responder verification) Discounts available: $100 off a single or family membership. (Must be paid in full annually.

*All Individuals over 21 years of age must have their own membership.

WAIVER: THE MEMBER(S) ACKNOWLEDGES AND ACCEPTS THE RISKS INHERENT IN THE USE OF THE FITNESS CENTER. THE MEMBER(S) HEREBY VOLUNTARILY ASSUMES THE RISK OF INJURY, ACCIDENT, DEATH, LOSS, COST, OR DAMAGE TO HIS OR HER PERSON OR PROPERTY WHICH MIGHT ARISE FROM THE USE OF THE FITNESS CENTER. THE MEMBER(S), HIS OR HER HEIRS, EXECUTORS, REPRESENTATIVE, OR ASSIGNS, HEREBY RELEASE MEMORIAL HOSPITAL FROM ALL CLAIMS OR LIABILITIES FOR PERSONAL INJURY OR PROPERTY DAMAGE OF ANY KIND SUSTAINED BY THE MEMBER WHILE ON THE FITNESS CENTER PREMISES, INCLUDING THE PARKING AREA.

BINDING CONTRACT: This agreement represents the complete understanding between the member(s) and the Fitness Center unless modified in writing by the parties. No representations, written or oral, other than those contained within this agreement are authorized by or binding upon the Fitness Center. If any term of this Agreement is to any extent invalid, illegal, or incapable of being enforced, then such term shall be excluded to the extent of such invalidity, illegality, or unenforceability; all other terms hereof shall remain in full force and effect. Memberships are NOT TRANSFERABLE. By registering for, participating in or attending Fitness Center programs, events, or other activities, the participant (or parent/guardian of a minor participant) irrevocably agrees to the use and distribution by the Fitness Center of his or her image (or of his minor child/ward) in photographs, video recordings, and any other electronic reproductions of such programs, events and activities for any purpose without inspection or approval and without compensation, rights to royalties, or any other consideration now and in the future.

PRIVACY POLICY – FOCUS FITNESS CENTER

This privacy policy explains how Memorial Hospital collects, uses, and protects personal information associated with your FOCUS Fitness Center membership, access, and payment arrangements.

Information Collection, Use, and Sharing
Memorial Hospital is the sole owner of the information collected from you for the purpose of managing your membership and related services. We collect only the information you voluntarily provide through direct contact, registration forms, or email. We do not rent or sell this information to any party.

Your information will be used to establish and maintain your membership, process payments, and communicate with you regarding FOCUS Fitness Center updates, schedules, rules, or changes to membership documents such as the fitness rules or waiver and release forms. Memorial Hospital will not share your information with any third party outside the organization unless legally required.

Unless you request otherwise, Memorial Hospital may contact you via email, text message, or telephone to inform you of membership updates, operational changes, or newly offered services related to the FOCUS Fitness Center.

Your Access to and Control Over Information
You may opt out of future communications from Memorial Hospital at any time. You may also request to:

• Review the personal data we have on file
• Update or correct any of your information
• Request deletion of your information
• Express concerns about how your information is used

To do so, please contact Memorial Hospital at 217-357-8500.

ADDITIONAL MEMBERSHIP AGREEMENT TERMS
1. MEMBER’S HEALTH WARRANTY. Member warrants and represents that member has no disability, impairment, or ailment preventing him/her from engaging in active or passive exercise that will be detrimental or harmful to his/her health, safety, or physical condition if he/she does so engage or participate. This representation is made by member knowing that management will rely upon the same in respect to the issuance of this Membership and Certificate and continuation of the same.

2. EXERCISES. All exercises, including the use of weights, number of repetitions, and use of any and all machines, equipment, and apparatus designed for exercising shall be at the member’s sole risk. Notwithstanding any consultation on exercise programs which may be provided by Fitness Center employees, it is hereby understood that the selection of exercise programs, methods, and types of equipment shall be entirely member’s responsibility, and Fitness Center shall not be liable to member for any claims, demands, injuries, damages, or actions arising due to injury to member’s person or property arising out of or in connection with the use by members of the services and facilities of Fitness Center or the premises where the same is located and member hereby holds Fitness Center, its employees and agents harmless from all claims which may be brought against them by member or on member’s behalf for any such injuries or claims aforesaid.

3. MEMBER’S INDEMNITY AGREEMENT. Member assumes full responsibility for any person who becomes a member under this contract and shall indemnify Fitness Center, its affiliates, agents, and employees against any and all liability incurred by them to such member who does not become a signatory.

4. RULES, REGULATIONS, AND SCHEDULES. Member agrees to abide by all the membership rules of Fitness Center which may be posted in writing or issued orally; and which may be amended from time-to-time at the Fitness Center’s sole discretion.

5. GUEST POLICY. Member warrants that no guest will accompany any member and understands access to fitness center is for members only.

6. SUSPENSION OF MEMBERSHIP. Management has the right to suspend and/or terminate any membership for non-payment of dues, program fees, or for behavior harmful to the enjoyment of the Fitness Center by other members (requiring payment of reinstatement fee for reinstatement.)

7. RIGHT TO TERMINATION AND CANCELLATION. Membership agreement may not be terminated other than (a) if a member dies, his/her estate shall be relieved of any further obligation for payments under the contract not then due and owing, (c) if services cease to be offered as stated in this contract, (d) with 30-day notice prior to the member renewal date. Memberships run continuously, and no temporary suspension or transfer is allowed because of travel schedules, or personal needs (exceptions will be made under some circumstances with prior notice, in the discretion of Fitness Center.)

8. LAPSE OF MEMBERSHIP. A membership shall be deemed to be lapsed on the day following their renewal date for those on full payment plan. Access code to the fitness center will be disabled. Lapsed Memberships shall not carry any residual privileges, and member shall be required to re-apply.

9. MEMBER’S OBLIGATIONS. Except upon proper expressed cancellation and transfer rights, member shall not be relieved of his/her obligations to make payment agreed to, and no deduction or allowance from any said payments shall be made, by reason at member’s failure to attend or use the center’s facilities. (Member dues compensate the center for a period of time when the member is eligible to use facilities and is no way related to actual usage of the center.)

10. DISHONORED CHECK OR BANK DRAFT. If any check or draft payable to Fitness Center is not honored, in addition to the other rights it may have, then Fitness Center shall have the rights to: (a) Assess a service charge of $20.00 for each check or draft so dishonored to reimburse for the costs of collection. (b) Collect the current and past-due balance in any subsequent month. (c) Terminate this contract and collect the entire balance due for the remainder of the membership year.

11. ENTIRE AGREEMENT. This contract constitutes the entire agreement between the parties. Any promises, representations, understandings, and/or agreements pertaining directly or indirectly to the contract that are not contained herein are hereby waived. Subject to the Fitness Center’s right to change the rules from time to time, this contract may be modified only by an instrument in writing. Employees are not authorized to make any independent agreement with any patron that is not the center’s general policy.

12. MEMBERSHIP FEES. All balances are to be paid in full or set up a debit arrangement with the Fitness Center.

13. INTERRUPTION OF SERVICE. In case of long-term interruption of all services provided (example: fire or other disaster), Fitness Center reserves the right to freeze memberships and add the lost time once services resume. In the event of a temporary disruption in service, the member will not receive a refund or extension of membership time lost.

14. VALUABLES AND PERSONAL PROPERTY. Members are urged not to bring valuables onto Fitness Center premises. The Fitness Center and its employees or representatives shall not be liable for the loss, theft, or damage to the personal property of members.

15. CHANGE OF ADDRESS. All members must notify the Fitness Center in writing of any address or name changes.

16. ACCESS. Access to the Fitness Center will be cancelled at any time due to the lack of payment of membership dues. Once payment is made, then access will be reactivated.

17. Youth Member Access Policy

Members Aged 14–17: May use the facility independently between the hours of 6:00 AM and 9:00 PM. Outside of these hours, they must be accompanied by an adult member.

Members aged 12–13 May use the facility between 6:00 AM and 9:00 PM only when accompanied by an adult member.

All Other Times (Ages 12–17): Members aged 12 to 17 must be accompanied by an adult while on Fitness Center premises outside of the designated hours of 6:00 AM to 9:00 PM.

Children aged 5 and older may be included under a Family Membership or a Class-Only Membership solely for participation in group fitness classes, provided they are under the direct supervision of an adult listed on the membership during such classes.

Children aged 5-11 are not permitted in the main equipment area at any time, regardless of adult supervision.

18. SECURITY CAMERAS. Members acknowledge that the Fitness Center is monitored by security cameras at all times.

19. FITNESS CENTER. Reference in the application shall mean Memorial Hospital and relate to fitness facility located at 103 Randolph Street, Carthage, Illinois.