Letter of Understanding between My Gym and the Customer/User of the Facility.

*Please fill out a contract form for every person that is signing up.

*I will fill out forms for other family members in person at the gym
First name:
Last name:
Date of birth:
Home phone number:
Emergency phone number:
Moblie phone number:
Work phone number:
Place of Employment:
Physical Description (Please check one of each for security cameras)
Height: Short
Weight: Light
Hair: Light
PLEASE CHECK EACH BOX upon agreement:

I understand that I and the facility are under camera surveillance.
I have read and understood all the rules of conduct and facility policies and agree to abide by them, or access can and will be denied.
I am stating that I am in good health and/or have been seen recently by a physician who stated that I am capable of training with no physical disabilities to hinder my health, if I do so.
I understand that no one is responsible for my personal training; that I have trained in the past and I am fully knowledgeable of safe practices and routines that are beneficial to me. If not familiar, I will diligently seek advice from personal or written sources until I am familiar, even to the extent of hiring a personal trainer if needed. Therefore, I am solely responsible for my actions relating to my exercising and no other person, employee, supervising staff of this building, or persons involved with the equipment are responsible for my actions.
In order to be allowed the use of the equipment/facility, I understand that a monthly fee is due BEFORE my due date for the oncoming month of usage. By giving the following information for automatic payment, I am agreeing for the fitness facility management to access my account for my month (only) of usage. (The term “monthly usage” is used to designate the amount of time paid for in advance in order to be able to have access to the facility). This is not to be construed as actual usage of a month worth of workout time; or even that it is actually used at all. If a person fails to use his/her paid-for-in-advance monthly time to his/her advantage, that is the fault of the person paying, not the facility.
All cancellations must be done two business days before your due date and must be in written communication. No phone call cancellations will be accepted. No partial month payment or partial refunds will be accepted and/or incurred. No monthly statements will be mailed.
I agree that all minor parties and guests are my sole responsibility and are expected to follow the same policies as stated for myself. I understand that the entering adult should accompany minors. Children should be directed to the Kiddie Zone while adults are using the fitness center facility. I will assist my minor in cleaning up the Kiddie Zone after use.
If payment is not received BEFORE your payment due date, access will be denied for the upcoming month.
I authorize My Gym to pull automatic monthly payments for my membership with information provided.
Type Your Name (eSignature):
Click the submit button to go to the next step and pick your membership package