Please complete all areas, read and sign where indicated

Membership Agreement

CLUB INFORMATION
Company Name:	Aquila Fitness Consulting Systems, Ltd. Inc. (“Aquila”)
Aquila Address:	1221 Brickell Ave Suite #1060, Miami, FL 33131
Club Location Name:	Federal Fitness Center
Club Address (“Club Location”):	90 7^th ST, San Francisco, CA 94103

BUYER PERSONAL INFORMATION
First Name:	Last Name:	Email:
Address:
City:	State:	ZIP:
Birthdate:	Gender:
Cell Phone:	Work Phone:	*Employer:
*Emergency Contact:	*Relationship:	*Phone:

MEMBERSHIP PAYMENT INFORMATION

Membership Type & Monthly Payment Amount
PROMO CODE
Monthly Payment	See above
Total # of Payments	Month to Month
Initiation Fee	$40.00
Total Sales Price (The total cost of your membership including your initial Fees and sales taxes if any)	Monthly Payment Amount
Starting this date (mm/dd/yy)

Your membership starts TODAY. It is a monthly agreement, and therefore ends when cancelled in accordance with Section 2 below. You are required to pay your membership fee regardless of how long you choose to maintain your membership. Amounts paid are non-refundable subject to the cancellation rights described in Section 2.

OTHER FEES

Aquila will provide you with a membership card. You agree to pay $15.00 for each lost membership card.
Sign:

Clear

(draw your signature)

DEFAULT RETURN PAYMENTS

Should you default on any payment obligation as called for in this Agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. You also agree to pay $20.00 for returned check or rejected EFT or RCC (defined in Section 1). If you are paying monthly dues by EFT or RCC, Aquila reserves the right to draft via EFT all amounts owed by you including any and all default return fees and service fees subject to appropriate State and Federal Law.

SECTION 1: PERIODIC PAYMENT INFORMATION

You understand that the minimum term of your agreement is 30 days, unless cancelled in accordance with Section 2(A)(i). You want amounts you owe to Aquila under this Agreement (the "Agreement") to be paid through one of the following (select one):

Recurring charges to your debit card (“Debit”);
Recurring debits to your bank account through the ACH (an "EFT"); or
Recurring charges to your credit card account ("RCC")

Sign:

Clear

(draw your signature)

Your payment of your first month’s dues will be pro-rated based upon the effective date of the Membership Agreement and collected upon joining the Club. All subsequent payments will be due on the 1st of each month thereafter. Your signature below constitutes your authorization and agreement to the following terms for those debit, EFT or RCC charges. Specifically, you authorize Aquila, on a monthly basis, to charge your above listed credit or debit card account, or to initiate an EFT from the account you designated above or any successor or replacement card or account, for the monthly dues rate indicated above, and any other amounts you owe to Aquila under this Agreement, including any fees, and/or taxes. If your card or account expires or is replaced, you agree to promptly notify Aquila of your new card or account. This authorization will remain in effect until this Agreement is cancelled by you or Aquila pursuant to Section 2.

The amounts charged or debited to your account may vary each month from the amount shown above due to a change in the monthly dues, past unpaid dues and fees, increases in applicable taxes, or other fees and charges that you may owe. For EFT charges only, you understand that Aquila will notify you at least 10 days in advance of any EFT debit that will be more than one time the normal monthly debit amount. Upon your written request, Aquila will notify you if the amount of your EFT or RCC will vary by any amount.

If your EFT or RCC is rejected or returned unpaid for any reason, you authorize Aquila to resubmit it for payment one or more subsequent times in the future. If amounts you owe to Aquila are not paid because an EFT debit or RCC does not go through for any reason, your failure to pay those amounts may result in the suspension or termination of your membership, as described in Section 2(B)(i).

You may stop any EFT (debit to your checking or savings account by ACH or debit card) by notifying your financial institution at least 3 days before the scheduled transfer date.

SECTION 2: TERMINATION & CANCELLATION

2(A) YOUR RIGHT TO TERMINATE:

2(A)(i) Five-Day Cancellation:
You, the buyer, may cancel this agreement at any time prior to the midnight of the fifth business day of the health studio after the date of this agreement, excluding Sundays and holidays. To cancel this agreement, mail or deliver a signed and dated notice, or send a telegram which states that you, the buyer, are canceling this agreement, or words of similar effect. The notice shall be sent to Aquila at Federal Fitness Center / CO Aquila, 450 Golden Gate Ave, San Francisco CA 94102.

2(A)(ii) Cancellation due to Closure or Move of Club Location or Move Your Residence
You are entitled to a cancellation and refund under this Agreement if the Club Location goes out of business, or moves it’s facilities more than 5 driving miles and fails to provide, within 30 days, a facility of equal quality located within 5 driving miles of the Club Location at no additional cost to you. You are also entitled to a cancellation if you move more than 25 miles from the Club Location.

2(A)(iii) Cancellation Due to Death or Physical Inability:
You may cancel this Agreement if you die or become physically unable to avail yourself of a substantial portion of those services which you used from the commencement of the Agreement until the time of disability, with refund of funds paid or accepted in payment of the contract in an amount computed by dividing the contract price by the number of weeks in the contract term and multiplying the result by the number of weeks remaining in the contract term. The buyer or the buyer’s estate seeking relief under this paragraph may be required to provide proof of disability or death. A physical disability sufficient to warrant cancellation of the Agreement by the buyer shall be established if the buyer furnishes to the health studio a certification of such disability by a physician licensed to the extent the diagnosis or treatment is within the physician’s scope of practice. A refund shall be issued within 30 days after receipt of the notice of cancellation made pursuant to this paragraph.

2(A)(iv) 30 Day General cancellation policy:
You may cancel your membership at any time by filling out a cancellation request form and/or stop payroll deduction form (such notice must be given in writing to the Club Location). The notice of cancellation terminates automatically your obligation to any entity to whom Aquila has subrogated or assigned your Agreement. Accordingly, your membership will end 30 days from the date that Aquila receives your notice of cancellation.

Sign:

Clear

(draw your signature)

Even after your notice of cancellation, you authorize Aquila to charge or debit your account for any amounts you owe under this Agreement up to the date your membership ends and you agree to be bound by the terms and conditions of this Agreement until your membership ends. Notwithstanding any other language in this Agreement, you agree that all rights and obligations of both Aquila and you that are intended to survive cancellation of this Agreement will continue after cancellation and/or the end of your membership, to the extent permitted by law.

2(B) AQUILA’S RIGHT TO TERMINATE:

2(B)(i) Termination for Cause
Aquila may, at its option, terminate your membership due to: (1) failure to properly complete and endorse the Agreement; (2) failure to make timely payment; (3) your monthly EFT/RCC payments being interrupted and your failure to provide an alternative within a reasonable amount of time; (4) failure to follow any Aquila policies, Club Location rules, or the terms of this Agreement; or (5) conduct that is improper or harmful to the best interests of Aquila or its customers. Termination is effective upon the date that Aquila mails you a written notification of termination. You are responsible for all fees incurred up to the date of termination.

2(B)(ii) Termination Without Cause
Aquila reserves the right to terminate your membership for any reason not listed above and not inconsistent with or prohibited by law. Termination is effective upon the date that Aquila mails you a written notification of termination. You are responsible for all fees incurred up to the date of termination.

SECTION 3: WAIVER & RELEASE

You understand that you will not be allowed access to the Club Location unless you read, sign and deliver to Aquila this Waiver and Release. You recognize that participation in the activities offered at the Club Location is strictly voluntary and acknowledge that some of the activities in which you will participate may be of hazardous nature and include strenuous physical exercise or activity. Recognizing this, you hereby certify that, to the best of your knowledge, you do not have any medical, physical, mental, or emotional health condition that would hinder or prevent your active participation in such activities. You agree to complete and sign a Pre-Activity Fitness Profile Form before participating in any exercise activities at the Club Location.

In consideration of your request to participate in the activities offered at the Club Location, you acknowledge and agree to the following:

You hereby assume full responsibility for all risk of injury or loss which may result from your participation in the activities offered at the Club Location.
You agree to indemnify and hold harmless, release and forever discharge, Aquila and their affiliates and instructors (and their respective partners, officers, agents, employees, and other representatives of any of the foregoing) from any and all acts of negligence and all claims and demands whatsoever, which you, any third person, or any persons acting on their behalf, have or may have against any of said indemnified parties, by reason of any accident, illness, injury or death of any person or persons, or damage to or loss, theft or destruction of any property, arising or resulting directly or indirectly from participation in the activities offered by the Club Location and occurring during said participation, or any time subsequent thereto.
You represent and warrant to Aquila and its contractors and instructors that the answers you have given in your Pre-Activity Fitness Profile Form are true and accurate.
The terms of this Release will serve as a release and assumption of risk for you and your heirs, executors, and administrators and for all of your family members. If contractors and/or instructors are utilized at the Club Location, they shall be covered by this release without regard to the nature of such contractors’ or instructors’ relationship, if any, to Aquila.
Nothing herein shall be construed as a waiver of any rights or benefits, which would otherwise be available under any applicable medical or Worker’s Compensation insurance carried by or for the benefit of the undersigned participant.
Aquila reserves the right to exclude anyone from the Club Location for any reason, including but not limited to situations in which such person’s continued use may be dangerous, any inappropriate behavior, or any other violation of rules which may be established from time to time.

SECTION 4: ACCIDENT MEDICAL INSURANCE

PLEASE NOTE THAT AQUILA STRONGLY RECOMMENDS THAT EACH PARTICIPANT HAVE SOME TYPE OF ACCIDENT MEDICAL INSURANCE FOR HIS/HER OWN PROTECTION AND OBTAIN A PHYSICIAN’S RELEASE FOR EXERCISE.

SECTION 5: MEMBERSHIP RULES

You agree to follow all rules and regulations now in force or in the future adopted by Aquila.

SECTION 6: CLUB LOCATION RULES

No one may use the Club Location before signing and returning all required member registration forms, including the Membership Agreement and Pre-Activity Fitness Profile Form. Additionally, a membership card is required for access to the facility. All members must have their cards scanned upon entry.
No one under the age of eighteen (18) years is allowed on the premises.
New members should familiarize themselves with health club equipment with the assistance of the staff trainer.
Fitness equipment is used at the member’s and guest’s own risk. Please do not exceed the schedule suggested by the trainer without his/her consultation. Time restrictions may apply to some equipment when the Club Location is crowded, and these restrictions must be adhered to.
Free weights must be returned to racks when finished.
No smoking, food, or alcohol allowed in the facility. Water and other liquids must be kept in sports bottles, or other appropriately approved containers.
No running, jogging, or horseplay.
A shirt and soft-soled athletic shoes must be worn on the exercise floor. No belt buckles or studded clothing.
No cursing, loud or abusive language.
Please read equipment safety and instructional signs carefully before using machines.
Use the equipment as it is intended to be used.
Insert weight pins fully into weight stacks. Do not use add-on weights or other objects or training aids unless provided by the facility and intended specifically for such use.
Keep head and limbs clear of weights and other moving parts. Do not drop weight stacks—return weights to starting position slowly.
Do not attempt any repairs or adjustments that are not part of the intended use of equipment.
Stop exercise if you feel weak, faint, nauseous, or unduly tired or uncomfortable.
Do not leave items in the day-use lockers following your workout. Items will be removed and discarded at member’s risk.
Please deposit all used towels into the appropriate receptacle.

SECTION 7: RESERVATION OF RIGHTS

Aquila reserves the right at any time to alter the hours of operation, and the right to amend the cost of, add, modify and/or eliminate any program, facility, activity, class or service of any club, in our sole discretion. Classes and equipment are available subject to demand and may be crowded at peak hours or may be discontinued or times changed if demand fluctuates.

SECTION 8: DELIVERY OF NOTICES AND MAIL

By your signature below, you give express consent to: (1) receive membership communications by text message, e-mail, or other means; and (2) receive marketing communications from Aquila by any means including mail, telephone, pre-recorded message, text message, instant message and other means. You may change your communication privileges by e-mailing to Aquila.

SECTION 9: LIMITATION OF LIABILITY

Unless controlling legal authority requires otherwise, any award by an arbitrator or a court is limited to actual compensatory damages. Specifically, neither an arbitrator nor a court can award either party any indirect, special, incidental or consequential damages, even if one party represented to the other party that they might suffer these damages.

SECTION 10: GOVERNING LAW

To the full extent permissible by law, for purposes of any dispute arising out of this agreement, all parties hereto agree to submit to the sole and exclusive jurisdiction of the State of California.

SECTION 11: WAIVER OF JURY RIGHTS

In any civil action, counterclaim or proceeding, whether at law or in equity, which arises out of, concerns, or relates to this Agreement, and any and all transactions contemplated hereunder, the performance hereof, or the relationship created hereby, whether sounding in contract, tort, strict liability or otherwise, trial will be to a court of competent jurisdiction and not to a jury. Each party hereby irrevocably waives any right it may have to a trial by jury. Any party may file an original counterpart or a copy of this agreement with any court as written evidence of the consent of the parties hereto of the waiver of their right to trial by jury. Neither party has made or relied upon any oral representations to or by any other party regarding the enforceability of this provision. Each party has read and understands the effect of this jury waiver provision.

SECTION 12: SEVERABILITY

If any part of this agreement shall be held invalid, that part shall be deemed excluded from this agreement and the remainder of this agreement shall remain in full force and effect.

SECTION 13: ENTIRE AGREEMENT

The parties acknowledge that this Agreement constitutes their entire agreement. It cannot be amended except in written form executed by both parties.

BY SIGNING BELOW, YOU ACKNOWLEDGE RECEIPT OF: (1) A FULLY COMPLETED COPY OF THIS CONTRACT EXECUTED BY BOTH YOU AND AQUILA AT THE TIME OF THE AGREEMENT’S EXECUTION; AND (2) A COPY OF THE RULES AND REGULATIONS HEREIN.

Name:

Signature:

Clear

(draw your signature)

Date:

Aquila Fitness Consulting Systems, Ltd. | 1.800 806 8482 | www.aquilaltd.com

Pre-Activity Fitness Profile
Federal Fitness Center

Federal Fitness Center
90 7th Street
San Francisco, CA 94103

Information supplied is strictly confidential

1. Regular physical activity is relatively safe for most people. However, some individuals should check with their personal health care provider before starting an exercise program. The Pre-activity fitness profile form will help us identify possible risk factors that may affect your ability to exercise safely. Keep in mind that the presence of risk factors may not preclude you from beginning an exercise program, but it will assist us in addressing any medical concerns that may cause modifications to your exercise program.

2. All members & clients must complete Pre-Activity Fitness Profile Form to participate in exercise assessment and fitness consultation programs and services. If you require medical clearance take the last page titled “To be completed by personal health care provider” to your physician and have him/her complete that page.

If you opted for a Complimentary Exercise Assessment Testing please read below before your appointment.

1. Wear shorts, T-shirts and rubber shoes for the Fitness Profile test. Do not wear tights or a one piece top because they make it difficult to obtain accurate skinfold measurements.

2. Drink plenty of fluids over the 24-hour period preceding the test.

3. Abstain from food, tobacco, alcohol and caffeine for 3 hours prior to the test.

4. Avoid exercise or vigorous physical exercise the day of the test. It is best if the Fitness Profile test is the first exercise you perform for the day.

5. Get an adequate amount of sleep (6-8 hours) the night before the test.

6. Notify your fitness counselor if you have recently been ill. The test may need to be rescheduled.

Today’s Date

This form is not a substitute for a thorough physical examination, assessment and diagnosis by your physician. It is designed to identify adults for whom physical activity might be inappropriate at this time. Aquila strongly recommends that each client undergoes a medical examination before beginning any exercise programs.

Personal information
Name:
Sex:	Date of Birth:	Age:
Addess:
City:	State:	Zip:
E-mail:	Phone:

*Personal Health Care Provider:

*Business Phone:

Health history questionnaire
*Please read the following questions and answer each one honestly by checking Yes or No.
Yes	No	1. Have you ever been diagnosed with a heart condition?
Yes	No	2. Have you ever had a stroke?
Yes	No	3. Do you have epilepsy?
Yes	No	4. Are you pregnant?
Yes	No	5. Do you have diabetes?
Yes	No	6. Have you ever been diagnosed with pulmonary disease including emphysema, chronic bronchitis, or asthma?
Yes	No	7. Do you feel pain in your chest when you engage in physical activity?
Yes	No	8. In the past month, have you had chest pain when you were NOT doing physical activity?
Yes	No	9. Have you ever lost consciousness or have you ever lost control of your balance due to chronic dizziness?
*Have you ever experienced or been told you have any of the following?
Yes	No	10. Coronary angioplasty (CPTA) or cardiac surgery
Yes	No	11. Rapid heart beats or palpitations
Yes	No	12. Known heart murmur
Yes	No	13. Anemia
Yes	No	14. Phlebitis
Yes	No	15. Heart attack/ myocardial infarction
Yes	No	16. Metabolic disease (thyroid disorders, renal or liver disease)
Yes	No	17. High Blood Pressure (greater than 140/90 mm/hg)

! If you answered YES to any of the above questions you will need to obtain a medical clearance. Take the last page titled “To be completed by your health care provider” to your physician and have him/her complete the page.

Health history questionnaire
*Please read the following questions and answer each one honestly by checking Yes or No.
Yes	No	1. Are you currently being treated for a bone or joint problem, such as arthritis, that restricts your ability to exercise? Explain
Yes	No	2. Has anyone in your immediate family (parents/brothers/sisters) had a heart attack, stroke, or cardiovascular disease before age 55?
Yes	No	3. Do you have high cholesterol as reported by your physician (greater than 200mg/dl) or are you on cholesterol medication?
Yes	No	4. Do you smoke?
Yes	No	5. Are you currently exercising LESS than one hour per week?
Yes	No	6. Do you have an excessive accumulation of fat around the waist as indicated by your physician?
Yes	No	7. Have you gone through premature menopause without estrogen replacement therapy?
Yes	No	8. Are you a male over 45 years of age?
Yes	No	9. Are you a female over 55 years of age?
! If you answered YES to (2) two or more questions above we strongly encourage you to obtain a medical recommendation before exercising.
* Yes	No	10. Are you currently taking any medication? If yes, please specify:

	Name	Dosage	Purpose

Release and Waiver of Liability & Indemnity Agreement

IN CONSIDERATION for being permitted to participate in the Lanham Fitness Center Programs (hereafter the “Federal Fitness Center”), professionally managed by Aquila Fitness Consulting Systems, Ltd., “Aquila” for any purpose, including, but not limited to observation, participation in physical activities or using facilities or equipment in any way, I, on behalf of myself, my personal representatives, heirs, assigns, and next of kin, hereby acknowledge, agree, represent, and warrant with respect to any present or future entry into or use of the Lanham Fitness Center that:

1. Immediately upon entering, I will inspect the facilities of the Federral Fitness Center. I further warrant that remaining in the Federal Fitness Center after such entry for the purposes of either observation, participation in physical activities or use of any facilities or equipment constitutes an acknowledgment that I find and accept same as being safe and reasonably suited for the purposes of such observation, participation or use.

2. I am aware that the Federal Fitness Center has facilities and equipment for activities such as, but not limited to, weight training, walking, stair-climbing, jogging and running, rowing, aerobic activities, personal training, group fitness, and exercise testing. I understand that participation in physical activities and the use of facilities, services, programs or equipment at the Federal Fitness Center involves inherent risks, including but not limited to, death, serious neck and spinal injuries resulting in complete or partial paralysis, heart attacks, and injury to bones, joints, or muscles. I represent that I am voluntarily observing or participating in Federal Fitness Center activities. I hereby assume full responsibility for any risk of bodily injury, death or property damage (whether due to ordinary negligence or otherwise) arising in connection with my observation, participation in physical activities and use of Lanham Fitness Center facilities and equipment.

I declare that I intend to use some or all of the activities, facilities, programs, and services offered by Aquila Fitness Consulting Systems, Ltd. and I understand that each person, (myself included), has a different capacity for participating in such activities, facilities, programs and services. I am aware that all activities, services, and programs offered are educational, recreational, and/or self-directed in nature. I assume full responsibility, during and after my participation, for my choices to use or apply, at my own risk, any portion of the information or instruction I receive. I understand that part of the risk involved in undertaking any activity or program is relative to my own state of fitness or health (physical, mental, or emotional) and to the awareness, care and skill with which I conduct myself in that activity or program. I acknowledge that my choice to participate in any activity, service, and programs of Aquila Fitness Consulting Systems, Ltd. brings with it my assumption of those risks or results stemming from this choice and the fitness, health, care and skill that I possess and use.

I recognize that by participating in the activities, facilities, programs and services offered by Aquila Fitness Consulting Systems, Ltd., I may experience potential risks such as, but not limited to, transient light-headedness, fainting, abnormal blood pressure, chest discomfort, leg cramps, and nausea and that I freely and willingly assume any discomfort, fatigue, or any other symptoms that I may suffer during and after my participation. I understand that I may stop or delay my participation in any activity or procedure if I so desire and that I may also be requested to stop and rest by a supervising employee who observes any symptoms of distress or abnormal response. I further acknowledge and agree that the level of my participation in the exercise program and which exercises to perform must be determined by me, in consultation with my physician, and that the Lanham Fitness Center and Aquila Fitness Consulting Systems, Ltd. are not responsible for the intensity of my participation.

I recognize that exercise is not without some risk to the musculoskeletal system (symptoms such as, but not limited to, sprains, strains) and cardio respiratory system (symptoms such as, but not limited to, dizziness, fainting, abnormal heartbeat, discomfort in breathing, abnormal blood pressure, in rare instances heart attack or stroke). I hereby certify that I know of no medical problem (except for those that I indicated on the fitness profile questionnaire) that would increase my risk of illness or injury as a result of participation in a regular exercise program. I understand that the completion of this form will not result in any type of diagnosis of disease and that it is not intended as a substitute for consultation with my personal health care provider. I must consult my own personal health care provider for any evaluation of my health status. I hereby waive, discharge, absolve, hold harmless and forever release Aquila Fitness Consulting Systems, Ltd., and GSA, its employees, officers, agents, representatives, executors, affiliates, instructors, and all those associated from any and all liability arising out of any accident, injury, or loss sustained by me as a result of activities at or present in the Lanham Fitness Center managed by Aquila Fitness Consulting Systems, Ltd, facilities, activities, programs and services.

NAME:

SIGNATURE:

Clear

(draw your signature)

DATE:

Medical Release Form to be Completed by Personal Health Care Provider

If you require a medical release please have your health care provider complete this part. For quicker response you can fax this page to your health care provider.

Your patient, , has applied to participate in the Aquila fitness & wellness program.

We follow the American College of Sports Medicine (ACSM) guidelines for exercise participation. Your patient may be required to undergo the following as indicated by ACSM guidelines:

Physiological tests including:

Sub maximal graded exercise test (bicycle ergometer)
Measurements of resting heart rate & resting blood pressure
Body composition (skinfolds) analysis
Strength Test; 1RM (Repetition Maximum) arm curl or sit-ups in one minute or maximum amount of push ups Flexibility; sit and reach

Exercise Prescription Including:

Free Weights
Cardiovascular Exercise
Flexibility Exercise
Other:

Please complete below:

Resting Blood Pressure:	________ mm/Hg
Resting Pulse Rate:	________ b/min
Cholesterol:	________ mg/dl
HDL:	________ mg/dl (within 12 months)

Please check appropriate category:

	NORMAL	ABNORMAL
Lungs
Periph. Vasc.
Heart

Please comment on abnormal conditions identified above and include any relevant medical history.
_______________________________________________________________________________________

_______________________________________________________________________________________

Medical Clearance (check one): To my knowledge and based upon a current review of the above named patient I, the undersigned recommend:

No Physical Activity. Clearance denied at this time

Progressive Physical Activity:

with the avoidance of:
________________________________________________________________________

with the inclusion of:
__________________________________________________________________________

Unrestricted Physical Activity. There are no conditions or illnesses which would contraindicate his/her participation in an exercise program.

Name of Health Care Provider: __________________________________________________________	Telephone Number: ________________________________
Address: ________________________________________________________________________________________________

Signature of Health Care Provider:

________________________________________________________

Date: _____________________________

Member Information:

First Name:	Last Name:	Birth Date:
Address:	City:	State:
Zip:	Email:	Phone:

Relationship to minor:

Full Name and Birth Date of family members under the age of 18

#1	First Name:	Last Name:	Birth Date:
#2	First Name:	Last Name:	Birth Date:
#3	First Name:	Last Name:	Birth Date:
#4	First Name:	Last Name:	Birth Date:
#5	First Name:	Last Name:	Birth Date:
#6	First Name:	Last Name:	Birth Date:
#7	First Name:	Last Name:	Birth Date:
#8	First Name:	Last Name:	Birth Date:
#9	First Name:	Last Name:	Birth Date:
#10	First Name:	Last Name:	Birth Date:

Put Your Legal Signature Below

Clear

Date and Time Signed:

By checking this box I agree to have read and agree to the legal agreement above.

Send me emails about Account Management, Reminders, and Schedule Changes

Send a copy of this Membership Agreement to my email

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Our Privacy Policy

PLEASE NOTE THAT WAIVERKING, INC.’S (“WaiverKing”) PRIVACY POLICY HAS CHANGED EFFECTIVE May 25th, 2018.

You acknowledge that this privacy policy is a part of our website’s Terms of Service, and by accessing or using our website, you agree to be bound by all of its terms and conditions. IF YOU DO NOT AGREE TO THESE TERMS, AS UPDATED, PLEASE IMMEDIATELY STOP ACCESSING THE WEBSITE.

This document explains how we use your personal data.

When you sign up to use this service provider’s services, you do so through software provided by us, WaiverKing.

We are committed to ensuring the privacy of all users of our software and services and other visitors to our website. In this policy we explain how we hold, process and retain your personal data.

In respect to the account data, waiver data, and payment data (as defined below) that you provide to us, we are acting as a data processor on behalf of the service provider, who will be acting as the data controller in respect to such data. We will never store or control this data. You should direct any requests or queries you have regarding this data to the data controller, your service provider.

1. How we use your personal data

1.1. This section provides you with information about:

a) what personal data we hold and process;

b) in respect of personal data that we did not collect from you directly, where we obtained that data from, and what types of data we have collected;

c) the purposes for which we may process your personal data; and

d) the legal grounds on which we process your data.

Members and end users of our services

1.2. Account data. We may process information about you that you provide to us when you first sign up with a service provider ("account data"). This account data may include your name, address, telephone number, email address, date of birth, gender, employment details, and a photograph of you. We may use this data to create your account with the service provider when you sign up. This account data may be updated each time you complete a document through our software. We do not process your account data in any other way, or have access to it in any way.

The legal basis for this processing is our legitimate interests in providing our services to our clients, and ensuring that your account is updated each time that you complete a document through our software.

1.3. Waiver data. If you are using our software in order to sign documents such as a waiver, health form, contract, or questionnaire, we may process information that you put into such documents (“waiver data”). This waiver data may include your name, signature, date of birth, email address, information about your health and medical history, and any other information that you are required or requested to put into the document.

Once you have completed the document, we will process it, convert the document into a different format, and send it to your account with the service provider in order for it to be stored. We will never store your data permanently on our systems (although it may be stored in your account with your service provider).

The purpose for our processing your data in this way is to maintain and administer a complete and accurate record of the documents that you have signed and completed for your service provider. The legal basis for our processing your waiver data (to the extent that such waiver data does not class as a special category of personal data), will be our legitimate interests in providing our services to our clients who have asked you to complete the document in question, in order to ensure that a complete and accurate record of your signing and completing the documents is maintained and administered.

1.4. Sensitive Personal Data. During the course of using our software and services and providing us with information in order for us to provide our services to you, you may provide us with sensitive information about yourself (“sensitive data”). This sensitive data may include your health and medical history. We may use this data for providing our services to you. However, we will only process this sensitive data if you consent to us doing so.

[The consent to use this information needs to be provided by the parent for children under the age of 13. Anyone over the age of 13 can provide consent for use of their data under GDPR]

We comply with the requirements of the Children’s Online Privacy Protection Act. You must be at least 18 years old to have our permission to use the WaiverKing website. If you are between the ages of 13 and 17, or under the age of majority where you live, you represent that your legal guardian has reviewed and agreed to this privacy policy.

Other processing that we may carry out

1.5. Website data. We may process data about your use of our website and services ("website data"). The website data may include your IP address, geographical location, browser type and version, operating system, referral source, length of visit, page views and website navigation paths, as well as information about the timing, frequency and pattern of your service use. The source of the website data is our analytics tracking system. This website data may be processed for the purposes of analyzing the use of the website and services.

The legal basis for this processing is our legitimate interests, namely monitoring and improving our website and services.

We may also process this data for the purposes of diagnosing any issues we detect in relation to the use of our products or services. This data may be collected by our error-tracking software which is provided by Rollbar. We always try to ensure that any such data is anonymized so that you cannot be identified before it is stored in our records.

The legal basis for this processing is our legitimate interests in monitoring and improving our products and services.

1.6. Enquiry data. We may process information contained in any enquiry you submit to us regarding our products or services ("enquiry data"). The enquiry data may be processed for the purposes of offering, marketing and selling relevant products and/or services to you.

The legal basis for this processing is our legitimate interests, namely dealing with and responding to your enquiry appropriately.

1.7. Notification data. We may process information that you provide to us for the purpose of subscribing to our blog and press releases ("notification data"). The notification data may be processed for the purposes of sending you newsletters.

Where you are a corporate customer, the legal basis for this processing is our legitimate interests, namely the marketing of relevant products and services to you.

1.8. Correspondence data. We may process information contained in or relating to any communication that you send to us ("correspondence data"). The correspondence data may include the communication content and metadata associated with the communication. Our website will generate the metadata associated with communications made using the website contact forms. The correspondence data may be processed for the purposes of communicating with you and record-keeping.

The legal basis for this processing is our legitimate interests, namely the proper administration of our website and business and communications with users.

1.9. Payment data. We do not process payment information relating to goods and services that you purchase from the service provider. However, we do capture certain data relating to your payments and use them to update your account with the service provider ("payment data"). The payment data may include your contact details, your card details and the transaction details. The payment data may be processed for the purposes of updating your account with the service provider. The legal basis for this processing is our legitimate interests, namely our interest in the proper administration of our software and ensuring your account with the service provider is updated.

1.10. Other processing activities. In addition to the specific purposes for which we may process your personal data set out above, we may also process any of your personal data where such processing is necessary for compliance with a legal obligation to which we are subject, or in order to protect your vital interests or the vital interests of another natural person.

2. Providing your personal data to others

2.1. To our clients and partner service providers. The only third parties that we will disclose your personal data to are our clients (your service provider) who is the data controller in respect to the account data, waiver data, and payment data that we collect about you, and MINDBODY Inc. (“MINDBODY”), who provide software services to service providers in conjunction with the WaiverKing software. Your accounts are created by WaiverKing in the MINDBODY software on behalf of our clients.

2.2. Our insurers/professional advisers. We may disclose your personal data to our insurers, legal counsel, and/or professional advisers insofar as reasonably necessary for the purposes of obtaining and maintaining insurance coverage, managing risks, obtaining professional advice and managing legal disputes.

2.3. Where we provide your personal data to any third party. Where we share your personal data with any of the third parties referred to above, we will ensure this processing is protected by appropriate safeguards including a suitable data processing agreement with that third party.

2.4. To comply with legal obligations. In addition to the specific disclosures of personal data detailed above, we may also disclose your personal data where such disclosure is necessary for compliance with a legal obligation we have to comply with, or in order to protect your vital interests or the vital interests of another individual. This may include disclosing your personal data in response to lawful requests by public authorities, including to meet national security or law enforcement requirements.

2.5. We take reasonable and appropriate steps to ensure that third-party agents and service providers process your personal data in accordance with our Privacy Shield obligations and to stop and remediate any unauthorized processing. Under certain circumstances and pursuant to applicable laws, we may remain liable for the acts of our third-party agents or service providers who perform services on our behalf for their handling of your personal data that we transfer to them.

3. Transfers of your personal data outside of the European Economic Area

As further detailed below, we may transfer your personal data to our servers based in the US, as we are part of the Privacy Shield. Otherwise, where your personal data is transferred outside of the EEA, we will ensure that either (a) The European Commission has made an "adequacy decision" with respect to the data protection laws of the country to which it is transferred, or (b) we have entered into a suitable data processing agreement with the third party situated in that country to ensure the adequate protection of your data. In all cases, transfers outside of the EEA will be protected by appropriate safeguards.

4. Retaining and deleting personal data

4.1. Personal data that we process for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes. Details about members of our clients (your service provider) and end users of our services, including the account data, waiver data and sensitive personal data, will not be stored by WaiverKing.

4.2. Unless we contact you and obtain your consent for us to retain your personal data for a longer period, we will retain and delete your personal data as follows:

a) Website data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

b) Enquiry data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

c) Notification data (other than Notification data that is also Contact data) will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

d) Correspondence data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

4.3. We may retain your personal data where such retention is advisory and/or necessary for compliance with a legal obligation to which we are subject (such as with regard to applicable statutes of limitations, litigation or regulatory investigations), or in order to protect your vital interests or the vital interests of another natural person.

5. Your rights

5.1. You may instruct us to provide you with any personal information we hold about you; provision of such information will be subject to:

a) your request not being found to be unfounded or excessive, in which case a charge may apply; and

b) the supply of appropriate evidence of your identity (for this purpose, we will usually accept a notarized photocopy of your driver’s license and/or passport and an original copy of a utility bill showing your current address).

5.2. We may withhold personal information that you request to the extent permitted by law.

5.3. You may instruct us at any time not to process your personal information for marketing purposes.

5.4. In practice, you will usually expressly agree in advance to our use of your personal information for marketing purposes, or we will provide you with an opportunity to opt out of the use of your personal information for marketing purposes.

5.5. Your right to access your data. You have the right to ask us to confirm whether or not we process your personal data and, to have access to the personal data, and any additional information. That additional information includes the purposes for which we process your data, the categories of personal data we hold and the recipients of that personal data. You may request a copy of your personal data. The first copy will be provided free of charge, but we may charge a reasonable fee for additional copies.

5.6. Your right to correct. If we hold any inaccurate personal data about you, you have the right to have these inaccuracies corrected. Where necessary for the purposes of the processing, you also have the right to have any incomplete personal data about you completed.

5.7. Your right to erasure. In certain circumstances you have the right to have personal data that we hold about you erased. This will be done without undue delay. These circumstances include the following: (1) it is no longer necessary for us to hold those personal data in relation to the purposes for which they were originally collected or otherwise processed; (2) you withdraw your consent to any processing which requires consent; (3) the processing is for direct marketing purposes; and/or (4) the personal data have been unlawfully processed. However, there are certain general exclusions of the right to erasure, including where processing is necessary: for exercising the right of freedom of expression and information; for compliance with a legal obligation; or for establishing, exercising or defending legal claims.

5.8. Your right to restrict processing. In certain circumstances you have the right for the processing of your personal data to be restricted. These circumstances include the following: (1) you do not think that the personal data we hold about you is accurate; (2) your data is being processed unlawfully, but you do not want your data to be erased; (3) it is no longer necessary for us to hold your personal data for the purposes of our processing, but you still require that personal data in relation to a legal claim; and/or (4)you have objected to processing, and are waiting for that objection to be verified. Where processing has been restricted for one of these reasons, we may continue to store your personal data. However, we will only process it for other reasons: with your consent; in relation to a legal claim; for the protection of the rights of another natural or legal person; or for reasons of important public interest.

5.9. Your right to object to processing. You can object to us processing your personal data where our legal basis for the processing is that it is necessary for: the performance of a task carried out in the public interest, or in the exercise of any official authority vested in us; or the purposes of our legitimate interests or those of a third party. If you make an objection, we will stop processing your personal information unless we are able to: demonstrate compelling legitimate grounds for the processing, and that these legitimate grounds override your interests, rights and freedoms; or the processing is in relation to a legal claim.

5.10. Your right to object to direct marketing. You can object to us processing your personal data for direct marketing purposes. If you make an objection, we will stop processing your personal data for this purpose.

5.11. Your right to data portability. Where you have given us consent to process your personal data, or where we are processing your personal data for the performance of a contract, you have a legal right to receive a copy of the personal data we hold about you in a structured, commonly used and computer readable format. When a data request is made of us we will make available all applicable personal data to you in a computer readable format and will transmit your personal data to the appropriate third party pursuant to your instruction. We will not process your data in this way if we believe that it may pose a threat to the security of the data.

5.12. Your right to object for statistical purposes. You can object to us processing your personal data for statistical purposes on grounds relating to your particular situation, unless the processing is necessary for performing a task carried out for reasons of public interest.

5.13. Automated data processing. To the extent that the legal basis we are relying on for processing your personal data is consent, and where the processing is automated, you are entitled to receive your personal data from us in a structured, commonly used and computer-readable format. However, you may not have this right if it would adversely affect the rights and freedoms of others.

5.14. Complaints to a supervisory authority pursuant to the GDPR. If you think that our processing of your personal data infringes data protection laws, you can lodge a complaint with a supervisory authority responsible for data protection. You may do this in the EU member state of your habitual residence, your place of work or the place of the alleged infringement. This provision is only applicable if you are subject to the protections of the GDPR.

5.15. Complaints if you are not subject to the protections of the GDPR. If you think that our processing of your personal data infringes data protection laws you may contact us via email at privacy@waiverking.com or mail at: WaiverKing, Inc. 340 S Lemon Ave # 2018 Walnut, California 91789.

5.16. Right to withdraw consent. To the extent that the legal basis we are relying on for processing your personal data is consent, you are entitled to withdraw that consent at any time. Withdrawal will not affect the lawfulness of processing before the withdrawal.

5.17. Exercising your rights. You may exercise any of your rights in relation to your personal data by written notice to us in addition to the other methods specified above.

5.18. Point of Contact Data. PARAGRAPHS 5.1 – 5.17 SHALL NOT APPLY TO ACCOUNT DATA, WAIVER DATA, OR PAYMENT DATA OBTAINED OR PROCESSED BY WAIVERKING. IN RESPECT OF SUCH DATA:

a) WAIVERKING IS ACTING AS A PROCESSOR OF THAT DATA AND THE MAIN CONTRACTOR IS THE CONTROLLER;

b) YOU SHOULD CONTACT THE SERVICE PROVIDER TO EXERCISE THE RIGHTS SET OUT IN THIS PARAGRAPH 5

6. Links To Other Websites. Except as otherwise discussed in this privacy policy, this document only addresses the use and disclosure of information we collect from you. Other websites accessible through our website have their own privacy policies and data collection, use, and disclosure practices. Please consult each website’s privacy policy. We are not responsible for the policies or practices of third parties, including any third-party site or other products and services used in connection with WaiverKing’s services. The inclusion of a link does not imply endorsement of the linked site or service by us or by our affiliates.

We are not responsible for the collection, usage and disclosure policies and practices (including the data security practices) of other organizations, such as, Apple, Google, Microsoft, or any other operating system provider, wireless service provider or device manufacturer, including any personal data you disclose to other organizations through or in connection with WaiverKing’s services.

7. Security of Your Information. The security of personal data is a high priority at WaiverKing. We seek to use reasonable technical, administrative and physical safeguards to protect personal data within our organization. Unfortunately, no data transmission or storage system can be guaranteed to be 100% secure. As a result, while we strive to protect your personal data, you acknowledge that: (a) there are security and privacy limitations of the Internet which are beyond our control; (b) the security, integrity, and privacy of any and all information and data exchanged between you and us through the website cannot be guaranteed; and (c) any such information and data may be viewed or tampered with in transit by a third party.

8. IP Addresses and Cookies. Cookies are very small text files that are stored on your computer when you visit some websites.

We use cookies to help identify your computer, including where available, your IP address, operating system and browser type, for system administration so we can keep your activity secure, tailor your user experience and remember your preferences. This is statistical data and does not identify any individual. You are always free to decline our cookies if your browser permits, but some parts of our website may not work properly.

9. Your California Privacy Rights: Notice to California Customers and Opt-Out Information. Residents of the State of California, under certain provisions of the California Civil Code, have the right to request from companies conducting business in California a list of all third parties to which the company has disclosed certain personal data, as defined under California law, during the preceding year for third party direct marketing purposes. You are limited to one request per calendar year. In your request, you must supply appropriate evidence of your identity and attest to the fact that you are a California resident and provide a current California address for our response. You may request the information by writing to privacy@waiverking.com

Some web browsers incorporate a “Do Not Track” feature that signals to websites that you visit that you do not want to have your online activity tracked. California residents are entitled to know how WaiverKing, Inc. responds to “Do Not Track” signals. How browsers communicate the Do Not Track signal is not yet uniform, so a standard technological response has not yet been developed by the appropriate technology communities. For this reason, we do not respond to Do Not Track signals currently. To opt out of direct advertising on our website, please send a request to the address above. The effect of an opt-out will be to stop direct advertising, but it will still allow the collection of usage data for certain purposes (e.g., research, analytics, and internal online services operation purposes).

10. Privacy Shield Framework

10.1. WaiverKing Inc. complies with the EU-U.S. and Swiss-U.S. Privacy Shield Framework as set forth by the U.S. Department of Commerce regarding the collection, use, and retention of personal information transferred from the European Union and Switzerland to the United States. WaiverKing has certified to the Department of Commerce that it adheres to the Privacy Shield Principles. If there is any conflict between the terms in this privacy policy and the Privacy Shield Principles, the Privacy Shield Principles shall govern. To learn more about the Privacy Shield program, and to view our certification, please visit https://www.privacyshield.gov/

10.2. In compliance with the Privacy Shield Principles, WaiverKing commits to resolve complaints about our collection or use of your personal information. Any individual(s) with inquiries or complaints regarding our Privacy Shield policy should contact us at: privacy@waiverking.com

10.3. WaiverKing Inc. has further committed to refer unresolved Privacy Shield complaints to Judicial Arbitration and Mediation Services (JAMS), an alternative dispute resolution provider located in the United States. If you do not receive timely acknowledgment of your complaint from us, or if we have not addressed your complaint to your satisfaction, please visit https://www.jamsadr.com/eu-us-privacy-shield for more information or to file a complaint. The services of JAMS are provided at no cost to you. In certain situations, you may also have the right to pursue binding arbitration under the Privacy Shield Framework.

10.4. You may have the option to select binding arbitration for the resolution of your complaint under certain circumstances, provided you have taken the following steps: (1) raised your complaint directly with WaiverKing Inc. and provided us the opportunity to resolve the issue; (2) made use of the independent dispute resolution mechanism identified above; and (3) raised the issue through the relevant data protection authority and allowed the U.S. Department of Commerce an opportunity to resolve the complaint at no cost to you. For more information on binding arbitration, see U.S. Department of Commerce's Privacy Shield Framework: Annex I (Binding Arbitration).

10.5. For purposes of enforcing compliance with the Privacy Shield, WaiverKing is subject to the investigatory and enforcement authority of the U.S. Federal Trade Commission.

10.6. WaiverKing Inc. is controlled and operated by us from the United States. Except where you are a resident of a Member State of the EU, in which case paragraphs 2 and 3 above will apply, your personal data may be stored and processed in any country in which we engage service providers, and by using WaiverKing’s services you understand that your information may be transferred to countries outside of your country of residence, including the United States, which may have data protection rules that are different from those of your country. In certain circumstances, courts, law enforcement agencies, regulatory agencies or security authorities in those other countries may be entitled to access your personal data. Regardless of where your information is processed, we apply the same protections described in this policy.

11. Changes to the privacy policy. We reserve the right to change this policy at any time, without prior notice to you. Such changes, modifications, additions, or deletions shall be effective immediately upon notice thereof, which may be given by means including, but not limited to, issuing an e-mail to the e-mail address provided by you or posting the revised policy on this page. You acknowledge and agree that it is your responsibility to maintain a valid e-mail address and/or review the WaiverKing website and this policy periodically, and be aware of any modifications. Your continued use of the WaiverKing website after such modifications will constitute your: (a) acknowledgment of the modified policy; and (b) agreement to abide and be bound by the modified policy.

12. Our details

12.1. This website and software is owned and operated by WaiverKing Inc.

12.2. We are registered in the state of California under registration number C3518177, and our registered office is at 340 S Lemon Avenue, # 2018 Walnut, California 91789.

12.3. You can contact us:

a) by mail, using the postal address given above;

b) using our website contact form;

c) by telephone, on the contact number published on our website from time to time; or

d) by email, using the email address published on our website from time to time.

13. Data protection officer

Our data protection officer may be contacted via email: privacy@waiverking.com, or telephone: +1 (888) 211-6693.

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