Membership Agreement
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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Location {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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City, State, Zip {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Referred By {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Membership Option {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Payment Information
ACH Processing
Bank Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Routing Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Account Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Credit Card Processing
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Exp. Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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CVV Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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By signing below, I acknowledge that I have fully reviewed and been provided with a copy of this Membership Agreement and agree to abide by all the following terms and obligations.
- I understand that, except as herein provided, the Membership Agreement is non-cancelable.
- I understand and agree that my failure, for whatever reason, to utilize, attend, or participate in the fitness classes and programs provided by the Seung-ni Fit Club during the term of the Membership Agreement, does not and shall not relieve me of my binding obligation and responsibility to pay in full the Balance Due under the Membership Agreement.
- The member hereby represents that except for any medical conditions disclosed to the Seung-ni Fit Club prior to entering this Membership Agreement, he/she is physically fit and has no other medical condition(s) that would otherwise restrict or limit his/her ability to safely and fully abide by all Safety Rules of the Fit Club.
- The member agrees to abidy by all Safety Rules of the Fit Club.
- I understand that if I default, I will pay all costs of collection, including, but not limited to, collection agency fees up to fifty (50%) percent of the unpaid balance, court costs, and reasonable attorney's fees, all of which may be paid or incurred by the Fit Club.
- I understand that I may be liable for the following fees should any of the following occur: re-clear customer check ($5.00 fee); declined credit card debit ($15.00 fee); unpaid credit card charge back ($25.00 fee); scheduled payments received more than ten (10) days after due date ($10.00 fee); subject to appropriate state and federal law.
You may cancel this Membership Agreement without any penalty or further obligation within three (3) business days from the date of this Membership Agreement, excluding Sundays and holidays. Notice of cancellation must be in writing and mailed to the Fit Club.
Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Guardian Signature (if under age 18) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Emergency Contact Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Emergency Contact Phone Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Relationship to you {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Physician's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Physician's Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Medical History
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Medical Illnesses {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Current Medications {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Surgery History {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Injury History {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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