Owen County Fitness, LLC Membership Agreement

Full Name (required):

MaleFemale

Street (PO Box) (required):

City: State: Zip:

Date of Birth (required):

Home Phone:

Cell Phone (required):

Work Phone:

Your Silver Sneakers Number

Your Email (required)

 

The undersigned (“Member”) desires to become a member of OwenCounty Fitness, LLC, and agrees to the following terms and conditions:

1. SILVER SNEAKER AGREEMENT. Please consult with your physician before beginning any exercise program.

I acknowledge that I have voluntarily chosen to participate in one or more physical exercise or fitness activity or sport programs (the “Programs”). I acknowledge (i) the nature of the risks of the particular Programs in which I have chosen to participate, and (ii) the strenuous nature of those Programs. I understand, for example, the risks associated with physical injury, abnormal blood pressure, heart attack and even death; as well as the risks associated with the negligence of a Tivity Health Services, LLC participating location and any other organization or individual participating or involved in providing or promoting any classes, functions, Programs, testing, or other activities that I participate in as a Tivity HealthTM Program member (including without limitation the owners, officers, directors, employees, and representatives of any of the foregoing). By signing this document, I expressly assume all risk for my health and well-being and expressly assume the other risks associated with participating in the Programs, including, but not limited to, the negligence of a Tivity Health participating location and any other organization or individual participating or involved in providing or promoting any classes, functions, Programs, testing, or other activities that I participate in as a Tivity Health Program member (including without limitation the owners, officers, directors, employees, and representatives of the foregoing). I also hereby release, waive, discharge and covenant not to sue any class instructor, any Tivity Health participating location, any sponsoring organization, Tivity Health, Inc., or any of their subsidiaries or any other organization or individual providing or promoting classes, functions, Programs, testing, or other activities that I participated in as a Tivity Health Program member (including without limitation the owners, officers, directors, employees, and representatives of any of the foregoing) at any time hereafter, from any and all demands, liabilities, losses, or damages (including death, bodily injury or damage to property) caused or alleged to be caused in whole or in part by the negligence of any of the foregoing people or entities. In addition, I agree that Tivity Health may engage in – and I hereby expressly consent to – (i) the recording (in video and/or still photo format) of my participation in Tivity Health classes, workshops or other programs, and (ii) the publication or other use by Tivity Health of any such recordings in social media, broadcast media, print media, general advertising and similar purposes. I have read and understand this waiver and express assumption of risk. I have also read, understand, and will adhere to all guidelines and policies in regard to this benefit. This waiver and release shall survive the term of any agreement with a Tivity Health participating location or individual. In the event that my physician has recommended any limitations to my physical activity or I have experienced any of the following conditions, I hereby attest that I have informed my physician of the condition(s) and have obtained express consent from my physician to participate in the Programs.

• Chest pains while at rest and/or during exertion, previous heart attack or high blood pressure
• Any heart or circulatory conditions, such as vascular disease, stroke, chest pain, congestive heart failure, poor circulation to the legs, valvular heart disease, blood clots
• Frequent fast, irregular heartbeats OR very slow heartbeats
• Diabetes • Previous hip or spinal fracture (as an adult)
• Lung disease or shortness of breath after mild exertion, at rest, or in bed
• Open cuts on my feet that do not seem to heal
• An unexplained weight loss of ten (10) pounds or more in the past six (6) months
• More than two falls in the past year (no matter what the reason)
• More than one year since I have engaged in regular physical activity

2. MEMBERSHIP ACCESS. Member will be issued an access code, which will entitle Member to enter the premises and enjoy the use and benefit of the facilities of Owen County Fitness, LLC (collectively, the “Facility”). Member agrees not to allow any other person(s) access to the Facility using Member’s access code, and Member will not allow anyone to enter the Facility along with Member. Member agrees to safeguard the identity of the access code. Should Member violate any conditions of Membership Access, the membership may be revoked with no refund, and criminal prosecution may be applicable.

3. FACILITY AND HOURS OF OPERATION. The Facility is an unmanned fitness center and, with the exception of any closures for maintenance or any mandatory shutdowns by property management or any governmental authority, is open twenty-four (24) hours, three hundred sixty-five (365) days a year.

4. RELEASE AND WAIVER OF LIABILITY. Member recognizes that there are hazards and risks connected with physical fitness training. These risks include, but are not limited to, abnormal blood pressure, fainting, heart disorders and heart attack, dehydration, heat exhaustion, sprains, muscle strain, blisters, stress fracture, shin splints, tendonitis, cartilage tears, bursitis, back pain and bruising of joints. Exercise beyond one’s physical limits and/or accidents including exercise equipment may result in serious injury or even death. Member agrees to defend, indemnify and hold harmless Owen County Fitness, LLC against any loss, damage or expense incurred by reason of any claim or liability based upon personal injury (including death) or property damage arising out of the negligent or intentional action of Member. Member further agrees to release Owen County Fitness, LLC and its owners, officers, agents, employees and/or affiliates from any and all liability arising out of injury to Member, and further agrees to defend, indemnify and hold Owen County Fitness, LLC, its owners, officers, employees and/or affiliates free and harmless from against the same. Member acknowledges that surveillance cameras are in use for the protection of the Facility, its equipment and its members. Member hereby consents to being photographed and/or recorded for such purpose.

5. RULES AND REGULATIONS. Member acknowledges that Owen County Fitness, LLC operates under rules and regulations established for the safety and protection of its members, and agrees to be bound by such rules and regulations, as well by the rules and regulations subsequently approved and posted or otherwise published by Owen County Fitness, LLC. Such rules and regulations in effect from time to time are incorporated into this Agreement by reference. Facilities, equipment hours, service, regulations and policies are subject to change from time to time, without prior notice, in the sole discretion of Owen County Fitness, LLC. Member agrees to accept such reasonable change(s) as a condition of membership. Member additionally recognizes:

a. Under no circumstances shall Member move exercise equipment or use the equipment in any manner not authorized by Owen County Fitness, LLC.

b. All equipment shall be wiped down by Member after each use, with the supplies provided by Owen County Fitness, LLC.

c. This membership is for Member, and Member only, and Member will not give access to another individual.

d. Member will not misuse the equipment.

g. Owen County Fitness, LLC shall not be responsible for any lost or stolen items.

h. Member should not occupy any equipment for an extended period of time. Member should allow others waiting to use such equipment to work into their rotation.

i. The climate of the Facility is controlled by Owen County Fitness, LLC and is set to provide the optimum exercise environment for the majority of its members. Members shall not change or seek to change any environmental controls and shall never prop open any doors or windows to the Facility for any purpose.

6. PROHIBITED ACTIVITIES. Alcohol, drugs (including steroids), and smoking are prohibited within the Facility. Member agrees not to use the Facility or engage in any activity at Owen County Fitness, LLC while under the influence of drugs, alcohol, or medication that may impair Member’s ability to operate the equipment. No weapons of any kind are allowed. No photography, videotaping, filming or audio recording is permitted within the Facility without the express written consent of OwenCounty Fitness, LLC’s management. Owen County Fitness, LLC reserves the right, in its sole discretion, to limit the consumption of food or beverages, or to the use of outside equipment within the Facility. Gambling or gaming is prohibited within the Facility or on the premises.

7. DRESS POLICY. Owen County Fitness, LLC requires that members wear appropriate clothing and footwear while in the Facility. Appropriate clothing includes gym shorts, T-shirts, jogging suits, aerobic wear and sweat outfits. Street clothing and jeans are not considered appropriate clothing. Street shoes and black-soled shoes are prohibited within the Facility.

8. MEMBERSHIP TYPE. Owen County Fitness, LLC offers a full access membership (which allows access at all times).

9. COUNTERPARTS. This agreement may be executed simultaneously in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same agreement.

10. HEADINGS. The headings in this Agreement are inserted for convenience only and shall not constitute part of this Agreement.

11. BINDING EFFECT. This Agreement shall be binding upon, inure to the benefit of, and be enforceable by the parties hereto and their respective successors and assigns.

12. ENTIRE AGREEMENT. This Agreement, including the schedules, lists and other documents referred to in the Agreement which form a part of this Agreement, embody the entire agreement and understanding of the parties with respect to the subject matter contained in this Agreement. There are no restrictions, promises, warranties, covenants or undertakings, other than those set forth or referred to in this Agreement.

13. GOVERNING LAW. This Agreement, and all documents mentioned herein by reference, shall be governed by the laws of the State of Kentucky.

14. FURTHER ASSURANCES. The parties agree to execute such further documents as may be necessary, proper or convenient, for the purpose of fully effectuating the terms and conditions of this Agreement.

15. SUSPENSION AND TERMINATION. I understand that Owen County Fitness, LLC may suspend or terminate my membership at any time, in it sole and absolute discretion, for nonpayment of Membership Fees or for violation of any of Owen County Fitness, LLC’s policies and procedures, and that in so doing, Owen County Fitness, LLC assumes no further liability to adhere to the terms of this Agreement.

16. ACCEPTANCE OF TERMS. As a Member, I understand that I am entitled to use the Facility within the scope of the membership, and I am obligated to pay my dues and fees regardless of whether or not I use the Facility. I agree to promptly update Owen County Fitness, LLC of any changes in my contact information (including address, telephone number or email address) or change in credit card information.

I certify that I have read the foregoing Membership Agreement, and that by signing below, I acknowledge that I understand and agree to be bound by all of the terms and conditions hereof. I further acknowledge that a fully executed copy of this Membership Agreement has been provided to me. Make sure website allows them to download the agreement for their records.
 

Electronic Signature (required): Date:

TANNING CLIENT RELEASE AND INFORMED CONSENT FORM

PLEASE READ THE FOLLOWING INFORMATION AND ACKNOWLEDGE THAT YOU UNDERSTAND AND ACCEPT ALL PROVISIONS BY SIGNING BELOW. It is our intention to keep you as well informed about tanning as possible. This means informing you how to operate the tanning equipment. The proper procedure to follow in the tanning room will be clearly explained by a member of our staff. Please feel free to ask any questions. . IF YOU DO NOT DEVELOP A TAN OUTDOORS, YOU ARE UNLIKELY TO TAN-FROM THE USE OF ANY TANNING DEVICE

1. AVOID OVEREXPOSURE. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated Overexposure may cause photo aging of the skin, dryness, wrinkling and in some instances skin cancer. We recommend that you do not tan outdoors on days you are tanning indoors, that you do not tan if you currently have a sunburn and that you, at most, tan only once in a 24 hour period.

2. CERTAIN MEDICATIONS, Lotions and other Products may cause your skin to be more sensitive to UV Rays. Check with your physician or pharmacist if you are unsure about any medications you are taking or if you have had a problem with indoor or outdoor tanning in the past.

3. WEAR PROTECTIVE EYEWEAR. Failure to wear protective eyewear may result in severe burns or long term injury to injuries to the eyes.
I have read the contents of this consent form carefully and state that I am not aware of any medical condition or other reason that would prohibit me from tanning. I understand that I will not be allowed to exceed the maximum allowable time posted on the tanning device. I have been given adequate instructions for the proper use of the tanning equipment, understand the risks involved, and use it at my own risk. I hereby agree to release the owner operators and manufacturers from any damages that I might incur due to the use of this facility.

Electronic Signature (required): Date: