Health Club Membership Form

Health Club Membership Form
Member Name
First NameLast Name
Member Birth Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Member Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Member Business Email
example@example.com
Employer Name
Building Access Number
First 5 digits on the back of access card
Emergency Name
First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any medical
- If you answered "Yes" to any of the following questions, we strongly advise you to consult your doctor before commencing an exercise program. The Health Club staff can provide you with a Physician Referral Form.
Waiver: In exchange for permission to use the Health Club's property, facilities, staff, equipment, services, and programs today and on all future dates, I, for myself, my heirs, personal representatives, or assigns, do hereby release, waive, discharge, and covenant not to sue ABC Corporation, as well as any successors, to the fullest extent permitted by law.

Assumption of Risks: Physical exercise, by its very nature, entails certain inherent risks that cannot be eradicated, no matter how careful you are about avoiding injury.
Weightlifting, running, aerobic activities, classes, and sporting activities are just a few of the activities available at the Health Club.

Severability: The undersigned expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as the law of the State of Minnesota allows, and that if any portion of it is found to be invalid, the balance will continue in full legal force and effect to the maximum extent permissible.

I also agree to INDEMNIFY AND HOLD HARMLESS the Indemnified Parties from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney's fees, arising out of my involvement at the Health Club, and to reimburse them for any such expenses incurred.
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Clear
Should be Empty: