Membership Agreement Form

Member Name

Date

Email Address

Phone

Birth Date

Address

City

State

ZIP Code

Emergency Contact

Emergency Contact Phone Number

How did you here about us?

Type of Membership Type of Membership Single Joint Family Month to Month Prepaid

Additional Members

Payment authorization For the purposes of this payment authorization “i” refers to the new member whose name appears above as the primary account holder and whose signature appears below. The term “you”prefers to my financial institution identified above. I authorize you to pay monthly drafts on my behalf to South Maui Fitness the amount of $_________ Beginning __________________ these payments will continue until I submit written notice of cancellation. I agree that you will be fully protected in honoring these drafts and that your treatment of them and rights in respect to them are the same as if personally signed by me. I understand that I must notify South Maui Fitness of account changes by the start of the billing cycle, the 1st of each month and will incur a fee of an additional $20.00 per month for payment default. Payment authorization For the purposes of this payment authorization “i” refers to the new member whose name appears above as the primary account holder and whose signature appears below. The term “you”prefers to my financial institution identified above. I authorize you to pay monthly drafts on my behalf to South Maui Fitness the amount of $_________ Beginning __________________ these payments will continue until I submit written notice of cancellation. I agree that you will be fully protected in honoring these drafts and that your treatment of them and rights in respect to them are the same as if personally signed by me. I understand that I must notify South Maui Fitness of account changes by the start of the billing cycle, the 1st of each month and will incur a fee of an additional $20.00 per month for payment default. I agree

Amount of $

Beginning Date

Digital Signature

Assumption of Risk of Injury and Waiver of Claims I acknowledge that South Maui Fitness is an unsupervised fitness center and there is possible danger connected with any physical activity, including the dangers of physical injury and death. I assume all risks of injury and waive all rights to pursue money damages or any other relief of any kind arising out of (1) my entry into or upon South Maui Fitness or (2) my use of any equipment, machinery, or facilities in the fitness center or any South Maui Fitness sponsored event. On behalf of myself and my successors and assigns from and against any loss or damage that may be sustained by me or any person entering South Maui Fitness my guest. Assumption of Risk of Injury and Waiver of Claims I acknowledge that South Maui Fitness is an unsupervised fitness center and there is possible danger connected with any physical activity, including the dangers of physical injury and death. I assume all risks of injury and waive all rights to pursue money damages or any other relief of any kind arising out of (1) my entry into or upon South Maui Fitness or (2) my use of any equipment, machinery, or facilities in the fitness center or any South Maui Fitness sponsored event. On behalf of myself and my successors and assigns from and against any loss or damage that may be sustained by me or any person entering South Maui Fitness my guest. I agree

Initial

Policy and Procedures. I have read and agree to South Maui Fitness’s policies and procedures. I will not let anyone into the gym during non-staffed hours and I agree to ensure that the door closes behind me each time I enter and exit the facility. I understand that my membership will be immediately terminated without refund should I disobey any of the rules set forth. Policy and Procedures. I have read and agree to South Maui Fitness’s policies and procedures. I will not let anyone into the gym during non-staffed hours and I agree to ensure that the door closes behind me each time I enter and exit the facility. I understand that my membership will be immediately terminated without refund should I disobey any of the rules set forth. I agree

Initial