300 Highway 51 N.
Brookhaven, MS. 39601
(601) 823-5271
24 Hour Membership
Agreement
Name __________________________________________________
please print
Address ________________________________________________
________________________________________________
Phone __________________________________________________
Email __________________________________________________
ONE-YEAR MEMBERSHIP. YOU ARE AGREEING TO PURCHASE A ONE-YEAR 24 HOUR KDMC FITNESS CENTER MEMBERSHIP, WITH MEMBERSHIP FEES PAYABLE ON A MONTHLY BASIS AS DESCRIBED IN THIS CONTRACT.
RIGHT TO CANCELLATION. YOU MAY CANCEL THIS CONTRACT WITHIN THREE (3) BUSINESS DAYS OF SIGNING IT WITHOUT PENALTY OR FURTHER OBLIGATION BY SENDING A WRITTEN NOTICE OF YOUR CANCELLATION TO KDMC Fitness Center AT THE ABOVE ADDRESS. NOTIFICATION MUST BE RECEIVED BY THE CENTER WITHIN THREE (3) BUSINESS DAYS OF THE DATE OF THIS CONTRACT.
1.) Compliance with Rules.
I understand and agree that my 24 hour KDMC Fitness Center membership is a special membership based on trust and is a privilege, which can be taken away immediately by the Fitness Center manager for a violation of rules. As a 24 Hour KDMC Fitness member I agree to abide by all KDMC Fitness Center membership rules and 24 hour membership rules which will be posted at the facility or the Website and may be amended from time to time in the sole discretion of KDMC. A full copy of the current rules for the fitness center is attached. The additional rules below apply to a 24 Hour membership:
- No guests can attend with you except during staffed hours and then only if the guest has signed a liability waiver before using the KDMC Fitness Center.
- No swimming in the pool except during staffed hours. Any violation of this will result in immediate suspension of 24 Hour membership privileges.
- Only one 24 hour member may enter the Fitness Center front door at a time. Every member that enters the Fitness Center after staffed hours must register their entry by swiping their personal 24 hour membership card.
- Card sharing is strictly prohibited and will result in immediate loss of membership. Card sharing is viewed by ownership as stealing services from KDMC and from KDMC members as this action could cause a price increase for all members.
- 24 Hour members under the age of 15 must be accompanied by an adult age 21 or older during non-staffed hours.
I agree that improper unauthorized use of the facility may result in member suspension or cancellation. I agree not to let anyone use my card for any reason, and I agree to report any situation that appears to be card sharing to the manager. I understand that one act of card sharing will result in immediate membership suspension or termination. KDMC Fitness Center reserves the right to suspend or cancel the rights, privileges and membership of any member whose actions are detrimental to the use, safety, and enjoyment of the facilities.
Initial your acceptance to abide by the KDMC Fitness Center rules and special rules for the 24 hour membership here ________________
2.) Cancellation Rights. You may cancel this annual contract for one of the following reasons by delivering written notice of cancellation to the KDMC Fitness Center:
(a) If you move your residence or your place of employment more than twenty-five (25) miles from the Fitness Center (proof of new residence is required);
(b) Upon a doctor's order (copy required for file) indicating that you cannot physically or medically receive the services because of significant physical or medical disability for a period in excess of one month.
3.) Payment Authorization. By signing this one-year membership agreement, you are authorizing KDMC Fitness Center to electronically bill your bank account or credit card for your monthly dues (EFT, preauthorized check or credit card charge) on a monthly basis for a period of (12) twelve months in the amount of $_______. Copy of voided check required for bank draft information.
Initial your acceptance of the one year membership monthly rate here ____________
Name as it appears on credit card or bank draft:____________________________________
Bank Draft Routing # ____________________________________________________ Bank Draft Member Account #______________________________________________
or
Credit Card # __________________________________________
Credit Card Expiration date: ____________________________________________________
4.) No supervision. I understand that I am purchasing a 24 Hour Membership at a facility that allows access at any time. As such, I am aware that there will be no supervision or assistance except during staffed hours. Staffed hours are currently __________________, though such staffed hours may change at the sole discretion of KDMC. I am aware that if I get injured, become unconscious, suffer a stroke or heart attack or any other medical emergency or event that there will likely be no one to respond to my emergency and that KDMC Fitness Center has no duty to provide assistance to me while I am at the Fitness Center. I understand that even though KDMC Fitness Center is equipped with surveillance cameras, help will not be available during non-staffed hours. Initial your acceptance of this Section 4 of the agreement regarding “no supervision.”. ____________
5.) Acknowledgement of Risk and Waiver of Liability. I voluntarily assume the risk of injury, accident, death, loss, cost or damage to my person or property which might arise from my use of KDMC Fitness Center, and I agree to hold harmless and release the KDMC Fitness Center, King's Daughters Medical Center and all affiliated corporations, and its officers, directors, board members, agents, employees, representatives, executors, and all others from any and all liability. I also release all of those mentioned and any others acting on their behalf from any responsibility or liability for any injury or damage to myself including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities or the use of any equipment at the of KDMC Fitness Center. Initial your acceptance of the release of liability waiver as stated above in Section 5 of the agreement. ____________
6.) Cleared for exercise. I certify that I am in good physical health and I am able to undertake and engage in the range of physical activities in which I choose to participate at KDMC Fitness Center. I assume all responsibility for updating the facility with respect to any changes in my physical or mental condition and for reporting all injuries sustained at the facility to the Fitness Center staff. I understand and am aware that strength, flexibility, aerobic and anaerobic exercise, including the use of any equipment, is a potentially hazardous activity. I also understand that fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities and using equipment with knowledge of all the dangers involved. I do hereby agree to expressly assume and accept any and all risks of injury or death either accidental or otherwise. This waiver, release and indemnification agreement includes, without limitation, all injuries which may occur as a result of (a) my use of all amenities and equipment in the facility and my participation in any class, activity or personal training, (b) sudden unforeseen malfunctioning of any equipment and (c) my slipping or falling while in the facility, in or around the pool area, on the facility premises, including adjacent sidewalks and parking areas. I acknowledge that I have carefully read this waiver, release and indemnification agreement described in Section 5 and 6 and fully understand that it is a full and complete release of all liability.
Initial your acceptance of your certification that you are able to engage in exercise and your Acknowledgment of Risk and Waiver of Liability. ________
7.) General. This contract represents the complete understanding between you and KDMC Fitness Center. No representations, written or oral, other than those contained in this contract are authorized or binding upon KDMC and the KDMC Fitness Center. Should any part of this agreement due to legal or other regulatory changes become unenforceable, the remaining provisions within this agreement not impacted by such change shall remain in full force as originally written. You understand that you are obligated to pay your monthly membership fee for one year regardless of whether you use the facility. You agree to promptly update KDMC Fitness Center of any changes of address, phone, e-mail address and/or bank account/credit card information. At the end of the term of this one-year membership contract, it shall continue in effect on a month-to-month basis unless new rates have become effective or you provide notice of cancellation to terminate this contract.
I certify that I have read and understand all of the terms of the KDMC Fitness Center agreement and agree to abide by all of the terms of this agreement.
Print Name:____________________________________________
Signature:_______________________________________
Date: ______________________________
If under 18, parents or guardian signature is required.
Print names(s) of child(ren) in program:
__________________________________________________________________
Print name of co-applicant /parent:_____________________________________
Signature:_______________________________________
Date: ______________________________ |