Section 1: Accident Waiver, Release of Liability and Indemnity Agreement
I, ________________________________________(full name) hereby acknowledge that I voluntarily agree to participate in the Rough-Fit, Inc fitness program (hereinafter referred to as the “Program”). I am aware that my participation in the Program will be physically demanding possibly leading to possibly serious or fatal injuries. I am participating in the Program fully aware of the risks inherent in my participation and I voluntarily assume the risks of participating the Program.
_______________(Initial Here)
I recognize that exercise is not without varying degrees of risk to the musculoskeletal and/or cardio respiratory system. I hereby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by Rough-Fit, Inc.
_______________(Initial Here)
I understand and have been informed that there exists the possibility of adverse changes during the exercise program. I have been informed that these changes could include abnormal blood pressure, fainting, and disorder of heart rhythm, stroke and very rare instances of heart attack or even death.
________________(Initial Here)
As lawful consideration for being permitted to participate in the Program, I, on behalf of my heirs, executors, administrators, legal representatives, guardians, distributees, and assigns, hereby release, waive, discharge, and relinquish Rough-Fit, Inc and its agents, officers, principals and employees for any action or causes of action for personal injury, property damage, or wrongful death which may hereafter arise from participation in Rough-Fit, Inc fitness training. ________________(Initial Here)
I hereby agree to indemnify, save and hold harmless Rough-Fit, Inc and its agents, officers, principals and employees from any loss, liability, damage or cost (including attorney fees) which Rough-Fit, Inc and its agents, officers, principals and employees which may incur as a result of injury, death, or property damage to the undersigned, or from suit from such personal injury, death, and/or property damage to me. ________________(Initial Here)
This Agreement is intended to be as broad as is permissible under the law of the State of California and this Agreement shall be interpreted under the laws of the State of California. If any portion of this Agreement is invalid and/or is declared to be invalid by a Court of Law, the balance of the Agreement shall continue in full force and effect.
Section 2: Health Assessment
I, ________________, acknowledge that I recently completed the Rough-Fit Program on _______________. In order to participate in that Program, I completed a Health Assessment which was included in my application and which is hereby referenced. _______________(Initial Here)
Since completion of the Health Assessment and my participation in the Program (please pick one):
_____There have been no changes to the answers provided in my Health Assessment.
_____There have been changes to the answers provided in my Health Assessment as follows (please list changes in Detail
I, _______________, hereby assume full liability and responsibility for any for personal injury, property damage, or wrongful death that may occur due to my failure to disclose any changes in my Health Assessment from my prior application that arose since I completed the Assessment and participated in the Program. _______________(Initial Here)
Section 3: Payment Agreement
Fees are $____ for a _____week session______ days per week on Monday___, Tuesday____, Wednesday____, Thursday____, Friday____. All dues are payable in advance, at time of registration. If, within the first 3(three) days of your initial enrollment into the program, you decide that you do not wish to continue the fitness services program provided by Rough-Fit, Inc, you will be eligible for a refund, less a $50.00 administration fee. If you wish to cancel this Contract, you may do so by WRITTEN notice to: Rough-Fit, Inc, 12402 Browning Avenue, Santa Ana, CA 92705 The notice must state that you do not wish to be bound by the contract and must be received by Rough-Fit, Inc before midnight on the third business day after you begin your enrollment.
Payment Method:_________Check___________________________Visa___________________________MC
Signature________________________________________Exp Date________________________3 or 4 Digits on the back of the credit card_______
If any payment under this Agreement is returned, you will be charged a $20.00 returned item fee for checks and $20.00 for any credit card payments which are not honored for any reason.
The undersigned has read and voluntarily signs the release and waiver of liability and indemnity Agreement and further agrees that no oral representations, statements, or inducements apart from the foregoing written Agreement have been made. The undersigned acknowledges that he/she has read the foregoing paragraphs and is completely aware of the potential dangers incident to participation in the Program, and is fully aware of the legal consequences of signing the within instrument.
Policies on “Make Ups” and “Reschedules”
1. Make Ups – there are none. Schedules will need to be discussed prior to the beginning of a session. If your schedule is such that it is not predictable, you can purchase a “flex program” which allows you to purchase a block of days upfront. There is a time limit on when to use these days. A discussion with a Rough-Fit trainer will determine if you qualify for the “flex program”.
2. If you have purchased a 5 or 3 day session or Rough-Fit Results 1:1 and you do not participate on your scheduled day, you will forfeit that day.
3. If you join for a 6 month or 1 year period at the discounted rate and decide to leave before your contract is completed, we will back charged you the difference between the full rate and the discounted rate for the number of months you have already attended. If you return to Rough-Fit, you will not have the option of returning at a discounted rate.
4. Injuries, unfortunately do occur (although to date, Rough-Fit participants have experienced very few.) If time is taken off at the first signs of an injury, the opportunity of quick recovery is best. If unsure of a persistent injury, seek out a qualified health professional. During injuries, some Rough-Fit participants have elected to attend and participate in exercises that do not aggravate their injury.
5. Weather – Rough-Fit is held rain or shine. If you do not wish to participate in the rainy weather, you can purchase a “Flex Program”.
6. No Shows – if no participants have arrived within 15 minutes of the start time, the trainers will be free to leave.
7. Rough-Fit Results 1:1 – trainers require a minimum of 48 hours notice to reschedule a workout. If less than 48 hours of notice is provide, the workout will be billed.
8. Vacation Schedules – if you are signed up for a multi-month program and go on vacation, you will forfeit the days you are gone.
Participant Signature__________________________________________________
Print Name_________________________________________________________
Date______________________________________________________________
Rough-Fit, Inc Representative_________________________________________
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