DATE OF BIRTH:
□ MALE □ FEMALE
ADDRESS (PRINT): CITY: STATE:
DAYTIME/CELL PHONE: EMAIL:
(for club communication use only; not to be shared with 3rd parties)
EMERGENCY CONTACT (required): PHONE: RELATIONSHIP:
MEMBERSHIP TYPE: FOUNDING MEMBER– ⃝ $99 UnlimitedFounding membership – ⃝ $150 Couples Founding membership — ⃝ $150 unlimited membership – ⃝ $200 unlimited Couples membership (Required 6-month commitment)
FAMILY MEMBERS INCLUDED IN MEMBERSHIP:
1) 2) 3)
(add $20 per person 18 yrs+ per month in same household—applicable after couple membership)
MEMBERSHIP START DATE: END DATE:
MEMBERSHIP PAYMENT: Membership fee will be charged and processed on the membership start date. Future charges are automatic every month thereafter with a credit/debit card on file.
RENEWAL OPTION: Member may continue membership once original end date of agreement is reached. ReCharge reserves the right to cancel membership at any time for any reason.
CANCELLATION: Member may cancel membership at any time by giving a 30-day notice before next membership payment transaction. Membership may be cancelled if member becomes permanently disabled or dies.
FREEZE OPTION: Members may opt to freeze their membership if they will be absent 2 weeks or more due to temporary disability. Members must inform ReCharge staff and pay a $5.00 fee before absent dates. Membership will resume on the date indicated by member.
LIABILITY WAIVER: I agree unconditionally to hold ReCharge Fitness Recovery + Wellness Studio, its Owners, Agents, Employees, Members and/or Affiliates, completely blameless for any and all accidents, injuries, illnesses, ailments, mishaps, and/or incidents of any kind incurred or affected by while participating in any type of activity, function or program that is associated with ReCharge Fitness Recovery + Wellness Studio and/or any of its affiliates:
MEDICAL WAIVER: I indicated that my medical care provider releases me to participate in any and all of the classes and/or activities associated with my membership at ReCharge Fitness Recovery + Wellness Studio, and also take full responsibility for my participation there and unconditionally waive ReCharge Fitness Recovery + Wellness Studio and/or all of its affiliates of any and all liability.
CONTRACT WAIVER: “YOU, THE CONSUMER, MAY CANCEL THIS CONTRACT AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE THE CONTRACT IS EXECUTED. RECHARGE MUST REFUND CONSUMER’S MONEY WITHIN 30 DAYS IF THE CONTRACT IS CANCELLED WITHIN THREE BUSINESS DAYS.” In the event ReCharge closes and another wellness studio operated by the seller, or assigns of the seller, of this contract is not available within ten miles of the original location the member intends to patronize, ReCharge will refund to member a prorated share of the membership cost, based upon the unused membership time remaining according to the contract.
Last 4 digits of card
I have read and understand the above policies as well as the additional details of ReCharge Membership Terms and Conditions. I agree to the terms of the Membership Agreement. Please charge my card for $ starting today and continuing on the of each month.
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Membership Agreement
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