MONTH-TO-MONTH ADD ON MEMBERSHIP AGREEMENT

1. LET’S GET STARTED–MEMBERSHIP INFORMATION

Enrollment Date:	Club: Active Wellness Center at Petaluma
Name (last, first): ,	Gender:	Date of Birth:
Home Address:
City:	State:	Zip:
Phone:	Email:
Employer Name/Corporate Account (select ZZZ N/A if not listed):
* Emergency Contact (full name):
* Emergency Contact Phone:

* MEMBERSHIP PLAN

* Recurring Monthly Dues Rate (including taxes): Please provide required proof of Corporate, Senior, or Student or status to Petaluma@activewellnesscenter.com
* Additional Programming (including taxes) Monthly programming amount will be added to recurring standard membership rate
* Membership Start Date:
Monthly Recurring Billing Date:	Renews once a month on same day as the start date If the day of your billing date does not occur in every month (for example, the 31st), you will be billed on the last day of that month instead.
Registration Fee:	See Receipt
Prorated Dues:	See Receipt
Processing Fee:	$0.00

* Child + Youth Memberships ages 17 or under: additional charges per child and/or youth based on the current rates below will be added to the total recurring monthly billing amount.

Child Memberships ages 12 or under:

per Child: additional $75.00/month

Youth Memberships ages 13-17:

additional $60.00/month per youth member

Child’s name:

Child’s birthday:

* 2. ELECTRONIC FUNDS TRANSFER (EFT) ACCOUNT

Bill to Primary Member (First and Last Name):

*If the primary member is not a valid member, or insufficient information has been provided (no or incomplete primary member name), this agreement will be marked as incomplete/voided.

1201 Redwood Way • Petaluma, CA 94954 • phone 707.766.8080 • https://www.activewellnesscenter.com/petaluma

This is a month-to-month agreement and may be terminated as set forth herein.

This Membership Agreement (this “Agreement”) is between Active Wellness Center at Petaluma and the applicant for membership identified on page 1 of this Agreement (“Member”).

The Member (or Parent/Guardian, if Member is under 18) agrees to the membership plan indicated above, and is responsible for payment of all associated dues and charges. This agreement is to remain in effect until Active Wellness Center at Petaluma has received written notice from Member of its termination as indicated in Article III, Section 4, of this document, and the notice has become effective. I have read the terms of this agreement of this document and agree to abide by these terms.

Initial 10-Day Cancellation Policy: You, the buyer, may cancel this agreement at any time prior to midnight of the tenth calendar day after the date you signed this agreement to receive a full refund. To cancel complete the online cancelation form, deliver a signed cancelation notice to the club, or email the club manager. Written letters and email cancelations should state that you, the buyer, are canceling this agreement, or words of similar effect.

ARTICLE I. GENERAL POLICIES
SECTION 1. Eligibility for Membership. All membership agreements must be on forms prescribed by Active Wellness Center at Petaluma and are subject to approval by Active Wellness Center at Petaluma authorized personnel and payment of the required fees. Persons 18 years or older may become members.
SECTION 2. Third Party Beneficiary Rights. To the extent that any Facilities are owned or leased by an Owner other than Active Wellness Center at Petaluma, Active Wellness Center at Petaluma and Member agree that such Owner is an intended beneficiary of Article II, Article III Section 1, and Article IV Section 3 of this Agreement.
SECTION 3. Transfer of Agreement. Active Wellness Center at Petaluma may be managing this or other Facilities to which you have access under this agreement. In the event that Active Wellness Center at Petaluma management is terminated for any reason, Active Wellness Center at Petaluma may transfer any or all information (including your personally identifiable information) along with its obligations under this agreement, to the Facility’s new management.
SECTION 4. Annual Maintenance Fee. In addition to your monthly dues, an annual fee up to $100 may be charged to your account for purposes reasonably required to maintain the Facilities. Written notice will be given prior to assessing this fee.
SECTION 5. Data Privacy. Member acknowledges and agrees to the Privacy Policy located at https://www.activewellness.com/privacy
SECTION 6. Amendment of Rules and Regulations. Active Wellness Center at Petaluma may from time to time adopt rules, regulations or policies amending or supplementing those contained in this Agreement, and all members will be obligated to comply with such rules, regulations or policies. If new or amended rules or regulations are adopted, they will be published as “Additional or Substitute Rules and Regulations” unless they are of such a nature that publication would be inefficient or inappropriate, in which case notice shall be posted or members shall be otherwise advised of the amendment or supplement to the Rules and Regulations as necessary.
SECTION 7. Enforcement. If any provision of this Agreement or any supplement hereto is ruled invalid or unenforceable as applied to any person or circumstance, all other provisions of this Agreement shall remain valid and enforceable as applied to all other persons and circumstances.
SECTION 8. Agreement Modification. This Membership Agreement constitutes the entire and exclusive agreement of the parties, and supersedes all previous understandings and agreements between the parties, whether oral or written. Modifications or additions to the pre-printed terms of this Agreement, other than the completion of existing blanks, are unauthorized and will not be honored by Active Wellness Center at Petaluma. The terms of the Membership Agreement may only be modified in writing, on separate documentation, and any such modification must be signed and dated by both parties.

ARTICLE II. TERMS FOR RELEASE AND WAIVER OF LIABILITY & ASSUMPTION OF RISK & INDEMNIFICATION AGREEMENT
Member enters into this Release and Waiver, and Assumption of Risk, for Member and for any and all of Member’s guests and Member’s minor children who Member permits to use the Facilities with or without supervision.

In consideration of being permitted to enter upon, participate in and use the facilities, equipment, services and activities of or offered by Active Wellness Center at Petaluma and Active Wellness LLC, (including, without limitation, fitness programs offered via the internet or otherwise offsite (“Remote Programs”)), and their agents, owners, directors, officers, employees, partners, independent contractors, volunteers, and all other persons acting in any capacity on their behalf (collectively, the “Active Wellness Center at Petaluma Parties”), I, on behalf of myself, my guests, children, heirs, executors, administrators, successors and assigns, hereby:

1.             Acknowledge, understand and appreciate that my entry upon and/or use of the facilities, equipment, services and activities, including Remote Programs, of or offered by the Active Wellness Center at Petaluma Parties entails significant risks, both known and unknown, including, without limitation, the possibility of physical or emotional injury, infectious diseases (viral or bacterial, including but not limited to COVID-19), paralysis, death, other serious or catastrophic personal injuries, and loss or damage to personal property.

2.             Expressly agree and promise to accept and assume all of the risks, both known or unknown, that may arise as a result of my entry upon, participation in and use of the facilities, equipment, services and activities, including Remote Programs, of or offered by the Active Wellness Center at Petaluma Parties, whether such risks are caused or alleged to be caused by the negligent (actively or passively) acts or omissions of any the Active Wellness Center at Petaluma Parties. I hereby confirm that I am voluntarily entering upon, participating in and using the facilities, equipment, services and activities, including Remote Programs, of or offered by the Active Wellness Center at Petaluma Parties, and that I am electing to take such voluntary actions in spite of the risks. I acknowledge and agree that I am solely responsible for my safety and responsible entry upon, participation in, and use of the facilities, equipment, services and activities, including Remote Programs, of or offered by the Active Wellness Center at Petaluma Parties, whether or not supervised by an Active Wellness Center at Petaluma Party.

3.             Expressly and voluntarily release and forever discharge each of the Active Wellness Center at Petaluma Parties from any and all claims, demands, causes of action or liability for any loss, damages, injuries or death that I may suffer as a result of my entry upon, participation in or use of the facilities, equipment, services or activities, including Remote Programs, of or offered by the Active Wellness Center at Petaluma Parties, whether the same arises out of or results from any act, omission or conduct of one or more of the Active Wellness Center at Petaluma Parties, negligent (actively or passively) or otherwise.

4.             Expressly agree to hold harmless, indemnify and defend each of the Active Wellness Center at Petaluma Parties (with attorneys of each Active Wellness Center at Petaluma Party’s choice) from any and all claims, demands, causes of action, or liability for any loss, damages, injuries or death suffered by any other person in connection with my entry upon, participation in or use of the facilities, equipment, services or activities, including Remote Programs, of or offered by Active Wellness Center at Petaluma Parties, whether the same arises out of or results from any act, omission or conduct of one of more of the Active Wellness Center at Petaluma Parties, negligent (actively or passively) or otherwise. The agreement by me to hold harmless, indemnify and defend the Active Wellness Center at Petaluma Parties is immediate upon the assertion of any claims, demands, causes of action or liability by any other person and is not contingent or dependent upon a finding that my actions caused the loss, damages, injuries or death claimed. The agreement by me to hold harmless, indemnify and defend the Active Wellness Center at Petaluma Parties includes all consequential damages incurred by the Active Wellness Center at Petaluma Parties, or which otherwise would be incurred by the Active Wellness Center at Petaluma Parties absent this agreement, including, but not limited to, all attorney’s fees and costs, court and litigation costs, experts fees and costs, arbitrator fees and costs, mediator fees and costs, payment of any judgment, verdict, award or settlement on behalf of the Active Wellness Center at Petaluma Parties, and any other damages incurred by the Active Wellness Center at Petaluma Parties not included in the preceding list which arise as a direct or indirect consequence of the claims, demands, causes of action or liability asserted by any other person.

5.             ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS AGREEMENT AND AM AWARE THAT IT CONTAINS A WAIVER AND RELEASE OF LIABILITY AND THAT I AM GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE OR HOLD AN ACTIVE WELLNESS CENTER AT PETALUMA PARTY RESPONSIBLE FOR ANY INJURY WHICH I MAY SUFFER. I AM SIGNING THIS AGREEMENT OF MY OWN FREE WILL AND INTEND FOR MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

ARTICLE III. MEMBERSHIP
SECTION 1: NATURE OF MEMBERSHIP
Membership confers solely the right to use and enjoy certain Facilities in accordance with Active Wellness Center at Petaluma’s rules and regulations, as they may change from time to time. “Facilities” means the site or sites included in the membership privileges for the type of membership selected by Member on page 1 of this Agreement, the owner or lessee of which Facilities (in each case, the “Owner”) may be Active Wellness Center at Petaluma, or a third party. Membership does not confer any interest in the property or assets of Active Wellness Center at Petaluma or owner (if not Active Wellness Center at Petaluma) or any right to participate in the management or operations of Active Wellness Center at Petaluma, financially or otherwise.
SECTION 2: FEES & CHARGES
Registration Fees. As a condition of membership, Member shall pay a registration fee to Active Wellness Center at Petaluma. The amount, manner and time of payment of such fee shall be established by Active Wellness Center at Petaluma and may be changed from time to time. No portion of such fee will be refunded, after the Initial 10-Day Cancellation Policy period.
Dues. Member shall pay dues each month pursuant to an electronic funds transfer (EFT) as set forth on page 1 of this Agreement and may terminate his/her membership in accordance with the resignation procedures outlined in Article III, Section 4 of this Agreement. The dues for each category of membership shall be subject to change. The amount of such dues will be automatically transferred from Member’s bank account or credit card once each month on or after the due date for payment. A service fee may be assessed each month Active Wellness Center at Petaluma is unable, for any reason, to receive payment via EFT for any and all dues and/or charges owed to Active Wellness Center at Petaluma. Member will pay the dues of any and all additional members added to the Member’s membership. If Member elects to prepay his/her dues in advance, at the end of the prepaid period his/her membership dues will automatically revert to monthly dues billing.
Club Charges. Member may establish club charging privileges by providing a credit or debit card account authorization where indicated on page 1 of this Agreement. Such account information is stored electronically by Active Wellness Center at Petaluma for purchases by Member of in-house goods and services which are billed on the date of purchase and reflected on Member’s credit or debit card statement. Club Charge account information is stored electronically and will not be present at the time of purchase.
Late or Returned Item Charges. A Late Fee will be assessed for returned checks, insufficient funds, closed accounts, frozen or declined credit cards or similar circumstances, which result in late or delayed payment to Active Wellness Center at Petaluma. Member is responsible for providing accurate and updated information on their EFT account to insure timely receipt of payment. Active Wellness Center at Petaluma reserves the right to re-attempt collection of Member’s outstanding balance until such time as Member’s account is current.
Debit Cards. The processing date for debit cards may vary due to banking procedures and if charges are returned they will be subject to a Late Fee.
SECTION 3: FACILITIES & ACCESS
Facility Privileges. Privileges to use one or more Facilities vary depending upon the type of membership selected by Member, which is set forth on page 1 of this Agreement and may be changed from time to time.
Unavailability of Facilities. The obligation to pay dues is not dependent on the availability of all or any particular Facilities at all times, or the type or quantity of the classes or equipment offered at the Facilities. If at any time during the term of the contract, including a transfer of the contractual obligation, Active Wellness Center at Petaluma eliminates or substantially reduces the scope of the facilities, such as swimming pools or tennis courts, that were described in the contract, in an advertisement relating to the specific location, or in a written offer, and available to Member upon execution of this Agreement, Member may cancel the Agreement and receive a pro-rated refund. Member may not cancel the contract pursuant to this subdivision if Active Wellness Center at Petaluma, after giving reasonable notice, temporarily takes facilities out of operation for reasonable repairs, modifications, substitutions, or improvements. This subdivision shall not be interpreted to give Member the right to cancel the Agreement because of changes to the type or quantity of classes or equipment offered, provided Member is informed in the contract that Active Wellness Center at Petaluma reserves the right to make changes to the type or quantity of classes or equipment offered and the changes to the type or quantity of classes or equipment offered are reasonable under the circumstances.
SECTION 4: RESIGNATION & TERMINATION
Voluntary Resignation. The initial term of this Agreement is set forth on page 1 of this Agreement. Voluntary resignation during the initial term is permitted only if the entire amount owed and due through the end of the term is paid.
After Initial Term. After the initial term, Member may resign from Active Wellness Center at Petaluma by giving advance written notice to Active Wellness Center at Petaluma, via certified mail, or signed, dated form as provided by Active Wellness Center at Petaluma staff. Resignation requests are subject to the following terms and conditions: Notices received by Active Wellness Center at Petaluma will become effective 30 days after the date of receipt. The billing for the final 30-days will be prorated to exclude any days falling outside the 30 day period. Memberships on hold at the time of resignation will be reactivated for 30-days and charged for 30-days of full dues. A prorated portion of the current month's hold fee may be applied to the final dues payment. Dues will continue to accrue until the resignation is effective. No resignation will be effective and dues shall continue to be payable until all required payments have been received by Active Wellness Center at Petaluma. After Member’s resignation has become effective, he/she will not be subject to any further dues and all membership privileges will be terminated. Unless otherwise noted, all members on a family or corporate membership will be converted to individual memberships and subject to the dues of that category upon termination of this membership. If membership dues were prepaid, cancellation of membership within the prepaid time period will negate any prepayment discount and any refund will be calculated accordingly taking into account the full, non-discounted dues owing for such period.
Involuntary Termination. Active Wellness Center at Petaluma reserves the right at any time to decline, suspend, or terminate the membership or privileges of any member for failure to comply with the terms of this Agreement or with any rules and regulations adopted by the Active Wellness Center at Petaluma, or for any conduct the Active Wellness Center at Petaluma determines in its discretion to be improper or in any way contrary to the best interest of the Active Wellness Center at Petaluma and its membership, or due to a member or applicant's criminal conviction history. Membership may be terminated by written notification mailed to the last address shown on Active Wellness Center at Petaluma’s records for the member being terminated. The terminated member will remain liable for all dues and other indebtedness incurred prior to the date of termination, which shall be three (3) business days following the date on which the termination notice is mailed by Active Wellness Center at Petaluma.
Disability or Death. If Member is unable to use the Facilities as provided herein due to disability or death, he/she or his/her estate may terminate this Agreement and shall be relieved of the obligation to pay for services hereunder, and shall be refunded any amounts prepaid for such services, other than those received prior to death or the onset of disability. As used herein, the term “disability” means a condition that precludes Member from physically using the Facilities as verified in writing by a physician.
Resale of Membership. Member may not sell or otherwise transfer membership to another party without the prior express written approval of Active Wellness Center at Petaluma.
SECTION 5: CHANGES TO MEMBERSHIP STATUS
Membership Type Conversion. Member may request conversion to another membership type or network by providing written notice to Active Wellness Center at Petaluma. All membership conversion requests are subject to approval by Active Wellness Center at Petaluma management, and may require payment of additional fees.
Temporary Hold Status. Member may apply for a temporary “Hold” Status for a period of up to six (6) months and no more often than once every twelve (12) months by giving advance written notice to Active Wellness Center at Petaluma and paying all dues and other unpaid charges. Approved requests received by Active Wellness Center at Petaluma will become effective on the day requested for a minimum of 30-days and a maximum of six (6) months, in thirty day increments. During an approved Hold status, Member may not use any Facilities and is subject to reduced membership dues. If member is approved for a Hold Status during the initial twelve-month term, the months the membership is subject to the Hold Status will not be counted toward the Member’s initial twelve-month commitment. Member may return to regular membership status by notifying Active Wellness Center at Petaluma in writing and commencing payment of the prevailing dues for his/her membership type. Availability and rate of Hold status varies by principal Facilities used and membership type.

ARTICLE IV. RULES & REGULATIONS
SECTION 1: Registration. Member must check in and present his/her membership card each time he/she uses any Facilities.
SECTION 2: Attire. Proper attire is required for participants using any Facilities. Shirts and shoes are required in all public and recreational areas. Active Wellness Center at Petaluma may prohibit the use of any personal equipment on the premises of any Facilities.
SECTION 3: Damages. Any damage caused by Member, Member’s family members (including dependent children) or Member’s guest to any property of Active Wellness Center at Petaluma, owner (if not Active Wellness Center at Petaluma), or another person at any Facilities shall be paid for by Member.
SECTION 4. Hours of Operation. The hours of operation are adjusted seasonally and in accordance with the frequency of member usage. Active Wellness Center at Petaluma reserves the right to change the operating hours.
SECTION 5. Minors and Children.
MEMBERS
13-15 Years Old: Legal guardian must sign a membership agreement for the minor. Must be accompanied by an adult member at all times (unless participating in a staff-supervised program). Must follow Center code of conduct and demonstrate appropriate behavior and use of equipment at all times. Access may be revoked at any time at the discretion of the General Manager.
16-17 Years Old: Legal guardian must sign a membership agreement for the minor. Legal guardian is not required to remain on site. Must follow Center code of conduct and demonstrate appropriate behavior and use of equipment at all times. Access may be revoked at any time at the discretion of the General Manager.
12 Years Old and Younger: Children twelve years and younger are allowed only in designated areas for this age group, during designated hours of operation and with Active Wellness Center at Petaluma staff
supervision. Legal guardian is required to remain on site.
NON-MEMBERS
13-17 Years Old: Must have a guest liability waiver completed by a legal guardian. Must be accompanied by a legal guardian at all times. Must follow Center code of conduct and demonstrate appropriate behavior and use of equipment at all times. Access may be revoked at any time at the discretion of the General Manager.
12 Years Old and Younger: Children through the age of twelve (12) are only allowed in designated areas for this age group, during designated hours of operation and with Active Wellness Center at Petaluma staff
supervision.
STAFF-SUPERVISED PROGRAMS

All minors up through 15 years old, must be checked in at the front desk by an adult over the age of 18. Their minor waiver must be signed by the legal guardian in advance if the legal guardian is not the one dropping of the minor.
Drop-off for designated, staff-supervised programs/classes, such as swim team, and summer camps, is permitted only after being checked in at the front desk.
Drop off is available up to 15 minutes prior to the start of the program/class for 13-15 year olds
The adult dropping off a minor 0-12 years old must accompany minors through check-in and wait with the minor until the class/program starts.
The same adult that dropped off the minor must pick up the minor at the end of the program/class. After care is not available after a program/class ends.
Use of the locker room by 13-15 year olds is permitted for changing purposes only.
Active Wellness Center at Petaluma reserves the right to determine which class/programs qualify as “staff-supervised”. General group fitness classes are not considered “staff-supervised”.
Active Wellness Center at Petaluma reserves the right to revoke the drop-off privilege for anyone, at any time.

SECTION 6. Personal Business. Members may not use any Facilities for personal business without prior written approval by an authorized representative of Active Wellness Center at Petaluma.
SECTION 7. Replacement Items. Lost or stolen membership cards and locker keys will be subject to a replacement fee.
Warning: Use of steroids to increase strength or growth can cause serious health problems. Steroids can keep teenagers from growing to their full height; they can also cause heart disease, stroke, and damaged liver function. Men and women using steroids may develop fertility problems, personality changes, and acne. Men can also experience premature balding and development of breast tissue. These health hazards are in addition to the civil and criminal penalties for unauthorized sale, use, or exchange of anabolic steroids.

ARTICLE V. HIPAA AUTHORIZATION
SECTION 1. Objective:

1. We offer certain services which may require you to disclose protective health information (“PHI”) under HIPAA in order to use them. Such services may include but not be limited to the following: heart rate and other biometric tracking, condition-specific fitness programs, and dietary and other behavioral counseling.

2. You do not have to use these services in order to use the Facilities.

3. If you do use those services, you acknowledge that:

We will collect that information, such as, by way of example, your name, address, date of birth, sex, height, weight, other measurable physical characteristics, diagnosed medical conditions, biometrics such as heart rate and blood pressure, dietary information and guidance, responses to health questionnaires, actual results of workouts on “smart” equipment (eg. type of motion, intensity of effort, number of repetitions, times and dates), and additional health and IoT information.

Active Wellness is not a medical provider and the services Active Wellness provides are not a substitute for medical examination or treatment.

4. We will store your PHI in third-party applications, such as online health record platforms, the online databases of the providers of specific equipment we use to provide the services, and our own databases.
5. We agree to keep your PHI confidential.

We may use aggregated de-identified PHI to improve or promote our services, and we may disclose it to our clients including Active Wellness Center at Petaluma or Owner.
We or the third-party applications we use may offer you the option to connect your data to other third-party applications who are not in contract with us. If you choose to do that, then you agree that we have no responsibility for the use of your information which may result from your choice to connect to such other third-party applications.
By using those services, you agree to all of the above.
If you use those services and later change your mind, we will delete or de-identify your information as required under law, as soon as practical after you notify us in writing at the address below.

6. We may use your PHI:

to provide you with useful insights which may improve your experience and for general information purposes.
to present de-identified aggregates to our clients to enable them to assess the impact of our services on their population.
to present de-identified aggregates to potential clients and use in marketing.
to improve our services and design new services.

7. I, , give this Authorization to Active Wellness. I authorize Active Wellness to provide my PHI to my healthcare providers and to the providers of the services described in Section
1 above. The disclosure of my PHI is intended to enable the service providers described in Section 1 and my healthcare providers to better monitor my physical well-being. The authorization granted herein shall expire on earlier
of (i) the date on which my membership expires or terminates and (ii) the one year anniversary of the date of this Agreement.
The undersigned has the right to revoke this authorization in writing at any time by giving written notice to Active Wellness at the following address: P.O. Box 2358, San Francisco, CA 94126.
The undersigned’s treatment, payment, enrollment or eligibility for benefits is not conditioned on whether they signed the Authorization.
Any information disclosed per the Authorization may be re-disclosed by a recipient and is no longer protected by federal or state health privacy laws.

PHOTO RELEASE
I understand that while participating in activities at Active Wellness Center at Petaluma, I may be photographed or filmed. I hereby assign copyright of the resulting images to Active Wellness, LLC together with the right of reproduction either wholly or in part, including in advertising and promotion, and I undertake not to prosecute or to institute proceedings, claims or demands against Active Wellness, LLC or its agents in respect of any reasonable usage of the above mentioned photographs or footage.

MEMBER RESPONSIBILITY CODE OF CONDUCT
All members need to be knowledgeable of and responsible for complying with safe and healthful conduct to minimize the risk of communicable diseases. We ask members to follow the guidelines below:

Members who feel ill should stay home, follow appropriate self-care guidelines and/or contact their health care provider.

Members who have tested positive for COVID-19, or have knowingly come into close contact with someone who has, are to follow all isolation guidelines as outlined by the county you reside in.

Members are to follow all county mandates and guidelines as it relates to mask mandates, physical distancing, contact and gathering.

Wash hands frequently with water and soap for at least 20 seconds before entering the facility, after leaving the facility, and as needed during visits.

If soap and running water are not immediately available, use hand sanitizer that contains at least 60% alcohol. Hand sanitizing stations are placed throughout the facility.

Cover their mouth and nose when coughing or sneezing. Follow-up Immediately with hand washing or sanitizer as noted above.

Follow all equipment cleaning protocols as defined by site management. Wipe down every piece of equipment BEFORE use and again immediately AFTER use.

Support Active’s commitment to providing a safe environment for all by reporting incidents of non-compliance by others to Active staff.

Be kind and patient - we’re all learning how to adapt to this new normal.

* Member Name:
Member Signature:

Clear

(draw your signature)

Date:

1201 Redwood Way • Petaluma, CA 94954 • phone 707.766.8080 • https://www.activewellnesscenter.com/petaluma

PAR-Q
The Physical Activity Readiness Questionnaire for Everyone

The health benefits of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor OR a qualified exercise professional before becoming more physically active.

GENERAL HEALTH QUESTIONS
Please read the 7 questions below carefully and answer each one honestly. Check:		YES or NO
1.	Has your doctor ever said that you have a heart condition OR high blood pressure?
2.	Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
3.	Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).
4.	Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
5.	Are you currently taking prescribed medications for a chronic medical condition?
6.	Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.
7.	Has your doctor ever said that you should only do medically supervised physical activity?

If you answered NO to all of the questions above, you are cleared for physical activity.

Start becoming much more physically active – start slowly and build up gradually.
Follow Global Physical Activity Guidelines for your age (https://www.who.int/publications/i/item/9789240015128).
You may take part in a health and fitness appraisal. If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.
If you have any further questions, contact a qualified exercise professional.

If you answered YES to one or more of the questions above:

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
You may be able to do any activity you want - as long as your start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
Find out which community programs are safe and helpful for you.

Delay becoming more active if:

You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
You are pregnant - talk to your health care practitioner, your physician, a qualified exercise professional, and/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.
Your health changes - answer the questions on Pages 2 and 3 of this document and/or talk to your doctor or a qualified exercise professional before continuing with any physical activity program.

If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity

Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity. “I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.”

Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions.

1201 Redwood Way • Petaluma, CA 94954 • phone 707.766.8080 • https://www.activewellnesscenter.com/petaluma

Name of Adult Participant and/or Parent or Legal Guardian of Minor:

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:

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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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