Fitness 101 Membership Agreement

Fitness 101 Membership Agreement
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Waiver of Liability

By signing below, I agree that the use of Fitness 101 facilities shall be undertaken at my sole risk. I am in good physical health and suffer no physical impairment which renders use of Fitness 101 facilities unduly dangerous. I hereby waive and release Fitness 101, its officers, employees, and agents from all such liability and related claims, whether or not based on negligence or other fault. I further agree to indemnify Fitness 101 from any injury to my guests.
Signature*

Clear
Date*

MonthDayYear
Date
Membership Type*

Day Pass1-Week Pass20-Visit Pass1-Month PassUnlimited Access*Active and Fit / Silver and Fit
Additional Guest?

YesNo
Additional Guests can be added after enrolment.
1st Guest Name*

First NameLast Name
1st Guest Signature*

Clear
1st Guest Email*
example@example.com
1st Guest Phone Number*
Please enter a valid phone number.
Add Another Guests?

YesNo
2nd Guest Name*

First NameLast Name
2nd Guest Signature*

Clear
2nd Guest Email*
example@example.com
2nd Guest Phone Number*
Please enter a valid phone number.
Add Another Guests?

YesNo
3rd Guest Name*

First NameLast Name
3rd Guest Signature*

Clear
3rd Guest Email*
example@example.com
3rd Guest Phone Number*
Please enter a valid phone number.
Add Another Guests?

YesNo
4th Guest Name*

First NameLast Name
4th Guest Signature*

Clear
4th Guest Email*
example@example.com
4th Guest Phone Number*
Please enter a valid phone number.
Fitness ID:*
Total Price
*The fee for Unlimited Access is $65.00 per month (+$45.00 for each additional guest). Fees are due each month on the date of enrollment and delinquent after five days of the aforementioned date. A $20.00 handling fee will be charged on fees received five days after the monthly enrollment date. If fees are not paid within 30 days of the due date, the purchaser relinquishes any and all rights to use the facility. For requests to cancel Unlimited Access, please provide 30 days notice.
Payment Options*

Pay with CardPay with Cash / In-Person
An additional $5.00 monthly fee will be added for cash/check/in-person Unlimited Access payments. Please call or text 541-992-4466 ahead of time to ensure someone is on-site to accept payment.
Name On Card
Card Number
Expiration Date
CVV
Billing Address
ZIP Code
Comments
Optional
Should be Empty:

Fitness 101 Membership Agreement

Waiver of Liability