next level fitness, llc. release and hold harmless agreement

next.levelfitness.com

next level fitness, llc. release and hold harmless agreement

NEXT LEVEL FITNESS, LLC.

MEMBERSHIP AGREEMENT

First Name: ______________________ M. Initial: _____ Last Name: ______________________

Address: ________________________________________________________________________

City: ___________________ State: _____ Zip Code: _______ DOB: __/___/___

E-mail address: _________________________________________________________________

Phone #: (_____)_____-_______ (m) (_____)_____-_______ (w) (_____)_____-_______ (h)

Workout time of preference: __ 5:45 AM __ 9 AM __ 6 PM // T-shirt size: S M L XL 2XL

What type of membership do you want? Choose one

12-Month Plan: $60 per month 6-Month Plan: $70 per month Monthly Plan: $75 per month

I would like to make membership payment on _____ Annual or ____ Monthly basis.

Membership cancellation policy:

12-month membership:

_____ I understand written notice to cancel is required 30 days prior to renewal date

_____ I understand that if I move out of town, a letter from my employer or other relevant document stating my

move will be required

Monthly membership:

_____ I understand that written notice to cancel is required by the 25 th day of the month preceding month of

cancellation

Choose one billing method below & fill out appropriate box:

1. Auto-pay monthly bank draft (EFT) – attach voided check.

Name on Account: ____________________________________________________

Bank name and branch: ________________________________________________

Bank Routing #_______________________________________________________

Account #: __________________________________________________________

Signature: ___________________________________________ ___

NEXT LEVEL FITNESS, LLC.

P: (804) 909-5060 * F: (804) 217-6389

barbara@next-levelfitness.com

www.next-levelfitness.com


2. Name on Credit/debit card: _____________________________________________

VISA/MC: __________-____________-__________-___________

Exp Date: ____/____ /____ Zip code on cc billing address: ______

Signature: ______________________________________________

Payment policy:

_____ I understand my monthly dues will be deducted in advance from my bank account or Visa/MC for the

upcoming month on the 1st of each month.

_____ I will be responsible for any additional fees incurred due to insufficient funds at the time of billing.

_____ Balances still due after the 10th of the month will incur a $5 late fee.

Emergency contact:

First Name: ______________________ Last Name: ________________ _

Phone #: (_____)_____-_______ (m) (_____)_____-_____ _ (w) (_____)_____-______ (h)

Relationship: ____________________________________________________________________

I have read and agree to the membership and payment terms above.

___________________________________________ Date: ____/____/____

Signature

___________________________________________

Print name

NEXT LEVEL FITNESS, LLC.

P: (804) 909-5060 * F: (804) 217-6389

barbara@next-levelfitness.com

www.next-levelfitness.com


NEXT LEVEL FITNESS, LLC.

RELEASE AND HOLD HARMLESS AGREEMENT

I, the undersigned, hereby certify that my participation in the NEXT LEVEL FITNESS, LLC (NLF) is entirely voluntary.

I represent that I am in proper physical condition and am over 18 years of age and know of no reason why it would be

unsafe for me to participate in this fitness program. In consideration of being allowed to participate in any way in the

following events and activities, I acknowledge, appreciate, and agree that:

1. The risk of injury from the activities involved in any events provided by NLF staff is significant and includes, but is

not limited to, the following; drowning, near-drowning, sprains, strains, falling, fractures, heat stroke, other heat and

cold injuries, over-use syndrome, injuries involving vehicles, animal bites and stings, contact with poisonous plants,

acts of God, and the potential for permanent paralysis and death. These activities include, but are not limited to,

paddling, climbing, biking, hiking, running, swimming, calisthenics, heavy lifting, ascending, traversing or rappelling

fixed ropes, travel by boat, truck, car, or other convenience. While particular rules, equipment, and personal discipline

may reduce this risk, the risk of serious injury does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF

ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my

participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I

observe any unusual significant hazard during my presence or participation, I will remove myself from participation

and bring such to the attention of the responsible staff; and,

4. I hereby release and discharge for all time NLF, their agents, officers, employees, instructors and participating

members, and if applicable, owners and lessors of premises used to conduct the event from all liabilities to the

undersigned, or anyone representing the undersigned for any loss or damages, on account of any and all injury,

disability, death or damage to person or property, or any resulting arbitration costs WHETHER ARISING FROM

THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

5. I understand that I must rely on my own medical insurance in the event that I am injured while participating in these

events.

6. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY

UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT,

AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Signature: ________________________ Print name: ___________________________ Date: ___/___/___

PHOTO RELEASE (OPTIONAL)

I, ________________________ (name) hereby authorize the NLF to use my name and picture for commercial purposes

including but not limited to the website, brochures, and flyers. I hereby waive the right to any and all payment or

compensation for the use of my picture.

Signature

NEXT LEVEL FITNESS, LLC.

P: (804) 909-5060 * F: (804) 217-6389

barbara@next-levelfitness.com

www.next-levelfitness.com


FOR PARTICIPANTS UNDER 18, THE PARENT OR GUARDIAN MUST SIGN.

The undersigned, the parent and natural guardian or legal guardian of the above minor hereby executes the foregoing

Waiver and Release for and on behalf of the minor named herein. I hereby bind myself, the minor and all other assigns to

the terms of the Waiver and Release. I represent that I have legal capacity and authority to act for and on behalf of the

minor named herein, and I agree to indemnify and hold harmless the NLF Entity mentioned above for any claims or

liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf

of the minor in the execution of the Waiver and Release.

__________________________ __/__/__ ____________________________

Parent/Guardian’s name Date Email address

__________________________ ____________________________

Parent / Guardian’s signature Phone #

NEXT LEVEL FITNESS, LLC.

P: (804) 909-5060 * F: (804) 217-6389

barbara@next-levelfitness.com

www.next-levelfitness.com

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