Gym Membership Signup Form
Personal Information
Your Name
(Required)
First Name (Nombre) *
Last Name (Apellido) *
Your Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
How Can We Reach You?
We would love to chat with you. How can we get in touch?
Preferred Method of Contact
Email
Phone
Your Email Address
(Required)
Phone
(Required)
Select Your Gym Membership
Please select your preferred annual membership from the options listed below, and indicate if you would like to include any additional services.
Select Your Membership (Seleccione Su Membresía) *
(Required)
24 Month Contract (Contrato de 24 meses) | $29.99/month | $30.00 Enrollment Fee
12 Month Contract (Contrato de 12 meses) | $34.99/month | $30.00 Enrollment Fee
6 Month Contract (Contrato de 6 meses) | $39.99/month | $30.00 Enrollment Fee
1 Month (un mes) | $50.00 | No Enrollment Fee
Day Pass (Paso del día) | $10.00 | No Enrollment Fee
TRINE Students (ESTUDIANTES DE TRINE) | $29.99 | Special Price (Month-to-month)
Would you like to add a personal locker?
Select an option
Yes
No
Select Your Extras (Seleccione Sus Extras)
Locker Rent | 1 month | $10.00 | Keep the same locker (Guardar la misma taquilla por un mes es $10)
Would you like to add Tanning?
Select an option
Yes
No
Select Tanning Options (Seleccione Opciones de Bronceado)
Monthly Tanning (un mes) | 1 month | $29.99
Per Session Tanning (por sesión) | 1 session | $10.00
Tanning Safety Acknowledgment and Authorization
(Required)
At Club Fitness of Angola, Indiana, we prioritize the safety and well-being of our clients. Tanning can have various effects on different skin types, and it is crucial to understand the importance of tanning safety. By signing this form, you acknowledge that you have been informed about the following key aspects of tanning safety:
Danger - Ultraviolet Radiation - Follow Instructions!
Avoid too frequent or lengthy exposure. As with natural sunlight, exposure to a sunlamp may cause eye and skin injury, sunburn and allergic reaction. Repeated overexposure may cause chronic damage characterized by wrinkling, dryness, premature aging of the skin and skin cancer.
Wear protective eyewear!
Failure to use protective eyewear may result in severe burns or long-term injury to the eyes!
Ultraviolet radiation from sunlamps enhances the effects of the sun. Do not sunbathe before or after exposure to ultraviolet radiation.
An abnormal or increased sensitivity or burning may be caused by certain foods, medicines (including, but not limited to tranquilizers, diuretics, antibiotics, high blood pressure medication, birth control pills, and skin creams), cosmetics if you are using prescription or over yourself using a sunlamp or toiletries. Consult a physician or pharmacist before taking medication or using cosmetics if you are unsure of your reaction to ultraviolet radiation.
If you do not tan in the sun, you are unlikely to tan from the use of this product.
Use of a tanning device may not provide a protective base in regard to sun exposure.
ritize the safety and well-being of our clients. Tanning can have various effects on different skin types, and it is crucial to understand the importance of tanning safety. By signing this form, you acknowledge that you have been informed about the following key aspects of tanning safety:
Skin Type Evaluation: Understanding your skin type is essential to determine the appropriate exposure to UV rays. Different skin types react differently to tanning.
Controlled Exposure: It's important to start with a shorter exposure time and gradually increase it, to prevent skin damage.
Risks of Overexposure: Overexposure to UV rays can lead to skin damage, premature aging, and an increased risk of skin cancer.
Use of Protective Gear: Wearing protective eyewear during tanning sessions is mandatory to prevent eye damage.
Health Conditions and Medications: Some health conditions and medications can increase sensitivity to UV rays. Consult with your physician if you have any health concerns or are taking medication.
Frequency of Tanning: Limiting the frequency of tanning sessions to avoid cumulative exposure is recommended.
Hydration and Skin Care: Keeping your skin hydrated and using appropriate skin care products before and after tanning sessions is advised.
I acknowledge that
I have read and understood the importance of tanning safety as outlined by Club Fitness of Angola, Indiana.
I agree to
follow the safety guidelines and instructions provided by Club Fitness staff during my tanning sessions.
I am aware of
the risks associated with tanning and accept responsibility for my health and well-being in relation to tanning services provided at Club Fitness.
Health History and Medication
Kindly inform us if you are currently experiencing any health issues, have a history of medical conditions, or if you are taking any medications.
Do you have any serious medication conditions?
No
Not that I'm aware of
Yes
(Yes) I have the following medical conditions
Heart conditions (e.g., heart disease, arrhythmias)
Second ChoiceRespiratory conditions (e.g., severe asthma, COPD)
Neurological disorders (e.g., epilepsy, severe migraines)
Diabetes (particularly if insulin-dependent)
Recent surgeries or hospitalizations
High or low blood pressure issues
Joint or bone issues (e.g., severe arthritis, osteoporosis)
Chronic pain conditions
Autoimmune diseases (e.g., lupus, multiple sclerosis)
Severe allergies (particularly exercise-induced allergies)
How did you hear about us?
Internet search (e.g., Google)
Social media (e.g., Facebook, Instagram)
Friend or family referral
Local advertising (e.g., flyers, billboards)
Online advertising (e.g., banner ads, Google Ads)
Email newsletter
Event or workshop
News article or blog post
Radio or TV advertisement
Other (please specify)
Automatic Withdrawal Authorization Form and Contract
(Required)
I agree to the privacy Automatic Withdrawal Authorization Form policy.
I, the undersigned, hereby authorize Club Fitness LLC, to initiate debit entries and to initiate, if necessary, any adjustments for entries in error, to my (our) account indicated below and the financial institution named below to debit the same to such account. This authority is to remain in force until Club Fitness receives from me (or either of us) a 30 day written notification of termination. In the event of a termination I (we) agree to pay a cancellation fee of $85.00 on a 6 month contract and $115 on a 24 month contract. The contract length and the resulting fee in the event of a cancellation will be determined by the information entered on the "# of Months" line below. If I (we) neglect to pay any of these charges, I (we) are aware Club Fitness could receive up to three times these amounts if litigation becomes necessary. If I (we) do not have sufficient funds at the time of a withdrawal I (we) agree to pay the charge of a $20.00 fee.
Waiver and Release Form
(Required)
I agree to the Waiver and Release Form policy.
Because physical exercise can be and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You (each member, guest, and all participating family members) agree that if you engage in any physical exercise or activity, or use any club amenity on the premises including any sponsored club event, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property. This waiver and release of liability includes, without limitation, all injuries which may occur as a result of: (a) your use of all amenities and equipment in the facility and your participation in any activity, class, program, personal training or instruction, (b) the sudden and unforeseen malfunctioning of any equipment (c) our instruction, training, supervision, or dietary recommendations, and (d) your slipping/falling while in the club premises, including adjacent sidewalks and parking areas. You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. You expressly agree to release and discharge the health club, and all affiliates, employees, agents, representatives, successors, or assigns, from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the trainer or instructor for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of the club, its agents, and employees. If any portion of this release from liability shall be deemed by a court of competent jurisdiction to be invalid, then the rFormemainder of this release from liability shall remain in full force and effect, and the offending provision or provisions severed here from. The club will be unstaffed at times during each day. Anyone under 18 years old will be restricted from using the club while unstaffed. Emergency necklaces are mandatory if using bench presses while club is unstaffed. By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.
Digital Signature
(Required)
By providing your name, you acknowledge and agree to all the terms, conditions, and responsibilities associated with the facility and gym membership.
Gym Membership Signup Form
Personal Information
Your Name
(Required)
First Name (Nombre) *
Last Name (Apellido) *
Your Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
How Can We Reach You?
We would love to chat with you. How can we get in touch?
Preferred Method of Contact
Email
Phone
Your Email Address
(Required)
Phone
(Required)
Select Your Gym Membership
Please select your preferred annual membership from the options listed below, and indicate if you would like to include any additional services.
Select Your Membership (Seleccione Su Membresía) *
(Required)
24 Month Contract (Contrato de 24 meses) | $29.99/month | $30.00 Enrollment Fee
12 Month Contract (Contrato de 12 meses) | $34.99/month | $30.00 Enrollment Fee
6 Month Contract (Contrato de 6 meses) | $39.99/month | $30.00 Enrollment Fee
1 Month (un mes) | $50.00 | No Enrollment Fee
Day Pass (Paso del día) | $10.00 | No Enrollment Fee
TRINE Students (ESTUDIANTES DE TRINE) | $29.99 | Special Price (Month-to-month)
Would you like to add a personal locker?
Select an option
Yes
No
Select Your Extras (Seleccione Sus Extras)
Locker Rent | 1 month | $10.00 | Keep the same locker (Guardar la misma taquilla por un mes es $10)
Would you like to add Tanning?
Select an option
Yes
No
Select Tanning Options (Seleccione Opciones de Bronceado)
Monthly Tanning (un mes) | 1 month | $29.99
Per Session Tanning (por sesión) | 1 session | $10.00
Tanning Safety Acknowledgment and Authorization
(Required)
At Club Fitness of Angola, Indiana, we prioritize the safety and well-being of our clients. Tanning can have various effects on different skin types, and it is crucial to understand the importance of tanning safety. By signing this form, you acknowledge that you have been informed about the following key aspects of tanning safety:
Danger - Ultraviolet Radiation - Follow Instructions!
Avoid too frequent or lengthy exposure. As with natural sunlight, exposure to a sunlamp may cause eye and skin injury, sunburn and allergic reaction. Repeated overexposure may cause chronic damage characterized by wrinkling, dryness, premature aging of the skin and skin cancer.
Wear protective eyewear!
Failure to use protective eyewear may result in severe burns or long-term injury to the eyes!
Ultraviolet radiation from sunlamps enhances the effects of the sun. Do not sunbathe before or after exposure to ultraviolet radiation.
An abnormal or increased sensitivity or burning may be caused by certain foods, medicines (including, but not limited to tranquilizers, diuretics, antibiotics, high blood pressure medication, birth control pills, and skin creams), cosmetics if you are using prescription or over yourself using a sunlamp or toiletries. Consult a physician or pharmacist before taking medication or using cosmetics if you are unsure of your reaction to ultraviolet radiation.
If you do not tan in the sun, you are unlikely to tan from the use of this product.
Use of a tanning device may not provide a protective base in regard to sun exposure.
ritize the safety and well-being of our clients. Tanning can have various effects on different skin types, and it is crucial to understand the importance of tanning safety. By signing this form, you acknowledge that you have been informed about the following key aspects of tanning safety:
Skin Type Evaluation: Understanding your skin type is essential to determine the appropriate exposure to UV rays. Different skin types react differently to tanning.
Controlled Exposure: It's important to start with a shorter exposure time and gradually increase it, to prevent skin damage.
Risks of Overexposure: Overexposure to UV rays can lead to skin damage, premature aging, and an increased risk of skin cancer.
Use of Protective Gear: Wearing protective eyewear during tanning sessions is mandatory to prevent eye damage.
Health Conditions and Medications: Some health conditions and medications can increase sensitivity to UV rays. Consult with your physician if you have any health concerns or are taking medication.
Frequency of Tanning: Limiting the frequency of tanning sessions to avoid cumulative exposure is recommended.
Hydration and Skin Care: Keeping your skin hydrated and using appropriate skin care products before and after tanning sessions is advised.
I acknowledge that
I have read and understood the importance of tanning safety as outlined by Club Fitness of Angola, Indiana.
I agree to
follow the safety guidelines and instructions provided by Club Fitness staff during my tanning sessions.
I am aware of
the risks associated with tanning and accept responsibility for my health and well-being in relation to tanning services provided at Club Fitness.
Health History and Medication
Kindly inform us if you are currently experiencing any health issues, have a history of medical conditions, or if you are taking any medications.
Do you have any serious medication conditions?
No
Not that I'm aware of
Yes
(Yes) I have the following medical conditions
Heart conditions (e.g., heart disease, arrhythmias)
Second ChoiceRespiratory conditions (e.g., severe asthma, COPD)
Neurological disorders (e.g., epilepsy, severe migraines)
Diabetes (particularly if insulin-dependent)
Recent surgeries or hospitalizations
High or low blood pressure issues
Joint or bone issues (e.g., severe arthritis, osteoporosis)
Chronic pain conditions
Autoimmune diseases (e.g., lupus, multiple sclerosis)
Severe allergies (particularly exercise-induced allergies)
How did you hear about us?
Internet search (e.g., Google)
Social media (e.g., Facebook, Instagram)
Friend or family referral
Local advertising (e.g., flyers, billboards)
Online advertising (e.g., banner ads, Google Ads)
Email newsletter
Event or workshop
News article or blog post
Radio or TV advertisement
Other (please specify)
Automatic Withdrawal Authorization Form and Contract
(Required)
I agree to the privacy Automatic Withdrawal Authorization Form policy.
I, the undersigned, hereby authorize Club Fitness LLC, to initiate debit entries and to initiate, if necessary, any adjustments for entries in error, to my (our) account indicated below and the financial institution named below to debit the same to such account. This authority is to remain in force until Club Fitness receives from me (or either of us) a 30 day written notification of termination. In the event of a termination I (we) agree to pay a cancellation fee of $85.00 on a 6 month contract and $115 on a 24 month contract. The contract length and the resulting fee in the event of a cancellation will be determined by the information entered on the "# of Months" line below. If I (we) neglect to pay any of these charges, I (we) are aware Club Fitness could receive up to three times these amounts if litigation becomes necessary. If I (we) do not have sufficient funds at the time of a withdrawal I (we) agree to pay the charge of a $20.00 fee.
Waiver and Release Form
(Required)
I agree to the Waiver and Release Form policy.
Because physical exercise can be and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You (each member, guest, and all participating family members) agree that if you engage in any physical exercise or activity, or use any club amenity on the premises including any sponsored club event, you do so entirely at your own risk. Any recommendation for changes in diet including the use of food supplements, weight reduction and/or body building enhancement products are entirely your responsibility and you should consult a physician prior to undergoing any dietary or food supplement changes. You agree that you are voluntarily participating in these activities use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property. This waiver and release of liability includes, without limitation, all injuries which may occur as a result of: (a) your use of all amenities and equipment in the facility and your participation in any activity, class, program, personal training or instruction, (b) the sudden and unforeseen malfunctioning of any equipment (c) our instruction, training, supervision, or dietary recommendations, and (d) your slipping/falling while in the club premises, including adjacent sidewalks and parking areas. You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. You expressly agree to release and discharge the health club, and all affiliates, employees, agents, representatives, successors, or assigns, from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the trainer or instructor for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of the club, its agents, and employees. If any portion of this release from liability shall be deemed by a court of competent jurisdiction to be invalid, then the rFormemainder of this release from liability shall remain in full force and effect, and the offending provision or provisions severed here from. The club will be unstaffed at times during each day. Anyone under 18 years old will be restricted from using the club while unstaffed. Emergency necklaces are mandatory if using bench presses while club is unstaffed. By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.
Digital Signature
(Required)
By providing your name, you acknowledge and agree to all the terms, conditions, and responsibilities associated with the facility and gym membership.
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