Welcome!

How did you hear about us? How did you hear about us? Fit 406 Bootcamp member Facebook Instagram Drive by Other

Who?

Have you ever been a member at another bootcamp?

Employer (we have corporate discounts)

Name

Email Address

Cell Phone

Address

City

State

Zip

Birth Date

Emergency Contact

Phone

Do you exercise now? Do you exercise now? Yes No

How often per week?

Do you have Do you have Back pain Knee pain Shoulder pain High blood pressure Asthma Diabetes Heart condition Any other health conditions

What other conditions?

Agree to pay $20 for the first month Agree to pay $20 for the first month Yes sign me up

Start Date

End Date

Photography/ Video Release Photography/ Video Release Participants involved in any activities offered by Fit 406 Bootcamp may be photofraphed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the Fit 406 Bootcamp website or in any editorial, promotional or advertising material production and/or published by Fit 406

Express assumption of risk Express assumption of risk I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use of or failure of equipment; strains and sprains. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partners. I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under the direction of Fit 406 Bootcamp. I acknowledge that I have no physical impairments , injuries, or illnesses that will endanger me or others.

Release Release In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Fit 406 Bootcamp, I, the undersigned hereby release Fit 406 Bootcamp, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with Fit 406 Bootcamp to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.

Indemnification Indemnification The participant recognizes that there is risk involved in the types of activities offered by Fit 406 Bootcamp. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs,. I further agree to indemnify and hold harmless Fit 406 Bootcamp, their principals, agents, employees, and volunteers from liability for the injury or death of any person and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Fit 406 Bootcamp, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, and/or any area selected for training by Fit 406 Bootcamp.

Agreement to terms Agreement to terms I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing, it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

Membership options Membership options Month/Month $110/month (must give 30 days written cancelation notice) 12-month commitment $99/month (a monthly charge of $99 for a period of 12 months) If for any reason you cannot fulfill your 12 month commitment, you must give a 30 day notice to cancel. In addition a $99 cancellation fee will be applied. Couples month/month $170/month (must give 30 days written cancelation notice) Couples 12-month commitment $150/month. If for any reason you cannot fulfill your 12 month commitment, you must give a 30 cancelation notice. In addition a $99 cancellation fee will be applied. Military $85/ month (must give 30 days written cancellation notice) Student 25 years or younger $85/month (must give 30 days written cancellation notice) Senior 60 years or older $85/month (must give 30 days written cancellation notice) Corporate rate $85/ month with a 12 month commitment. If for any reason you cannot fulfill your 12 month commitment , you must give a 30 day cancelation notice. In addition a $99 cancellation fee will be applied.

Payment Terms Payment Terms I agree that I have received, read and understand my rights regarding cancelation and payment options and agree to the terms of this contract.

Payment Method Payment Method Credit/Debit Card Check

Credit/Debit Card Number

Expiration Date

CVC

Check Number

Automatic payment authorization Automatic payment authorization I hereby authorize Fit 406 Bootcamp to charge my credit card or debit card for any and all payments as indicated above. If I make a 12 month commitment, I authorize Fit 406 Bootcamp to charge my credit card or debit card for a monthly payment for 12 months, ending a year from the date of this contract, as indicated above. I further authorize my credit card company or Bank to make payments of the entities stated above by the method indicated in this agreement to post on my account. I also authorize Fit 406 Bootcamp to charge my payment account until payment is made. Charges will appear on your account from Fit 406 Bootcamp.