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: ___________________________________________ ___ 


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 


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




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 


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



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 # 


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

next level fitness, llc. release and hold harmless agreement

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