Vibration Fitness Studio Membership Enrollment

Vibration Fitness Studio Membership Enrollment

Complete this form to enroll as a member, provide health information, consent, and payment authorization for your fitness membership.
1. Member Information
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City*
State*
Zip Code*
2. Emergency Contact
Emergency Contact Name*

First NameLast Name
Relationship to Member*
Emergency Contact Phone Number*
Please enter a valid phone number.
3. Membership Type
Select your membership type(s)*

Monthly Unlimited8 Sessions / MonthDrop-In SessionPrivate Training Add-OnSenior / Mobility Package (Low-Impact)6-Month PrepaidAnnual Plan
Membership Start Date*

MonthDayYear
Date
Optional Add-Ons

Progress Tracking App Access
4. Health & Wellness Screening (Required)

Please answer truthfully to ensure safe use of vibration fitness equipment.
Do you currently experience any of the following?*

Cardio conditions or pacemakerSevere joint issuesVertigo or dizzinessSevere migrainesRecent surgery (last 12 weeks)Pregnant or possibly pregnantUncontrolled high blood pressureOther health concerns
Have you been cleared by a physician to participate in low-impact vibration exercise?*

YesNo
5. Liability Waiver & Assumption of Risk
I acknowledge that participation in vibration fitness training involves physical activity and inherent risks. I agree that:
1. I am voluntarily participating in this fitness program.
2. I assume all risks of injury or health complications.
3. The studio, its owners, staff, and affiliates are not liable for injuries, accidents, or health events.
4. I agree to follow all safety instructions and equipment guidelines.
5. I will disclose any medical concerns prior to participation.
Member Signature*

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Date of Signature*

MonthDayYear
Date
6. Media & Results Consent (Optional)
Please select your media and results consent preference

I grant permission for the studio to use my photo, progress results, or testimonials for marketing purposes.I do not grant permission.
Signature for Media Consent

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Date of Media Consent Signature

MonthDayYear
Date
7. Membership Payment Authorization

Due to security policies, sensitive payment card details are not collected in this form. Please contact the studio directly for payment processing or use the provided payment methods.
Name on Payment Method*
Payment Method*

VisaMastercardAmexDiscover
Payment Authorization Terms*

I authorize monthly recurring payments until canceled in writing.I understand there are no refunds on prepaid plans.I agree to a 30-day written cancellation notice.
Billing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Signature for Payment Authorization*

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Date of Payment Authorization Signature*

MonthDayYear
Date
8. Studio Policies
- All sessions must be booked in advance.
- Late arrivals may reduce session time.
- Clean athletic shoes required.
- No food or drinks on equipment.
- Notify staff immediately if feeling dizzy, light-headed, or uncomfortable.
- Membership may be suspended or terminated for safety violations.
I acknowledge that I have read and agree to all studio terms.
Signature for Studio Policies Agreement*

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Date of Studio Policies Agreement Signature*

MonthDayYear
Date
Should be Empty:

Vibration Fitness Studio Membership Enrollment

1. Member Information

2. Emergency Contact

3. Membership Type

4. Health & Wellness Screening (Required)

5. Liability Waiver & Assumption of Risk

6. Media & Results Consent (Optional)

7. Membership Payment Authorization

8. Studio Policies