Medical Screening and Release Evolve Personal Fitness & Gym is not a medical organization and its staff cannot provide medical advice. You are advised to consult with your physician prior to beginning this exercise program and encouraged to seek periodic medical check-ups. If you are under the care of a physician, taking prescription medication, or following a diet to treat an illness or disease, you should discuss this exercise program with your physician.
Please fill out the following to the best of your ability:
Medical info and risk factors (Please check any that apply)
Taking medication/supplements to help with weight loss?
High cholesterol (>200mg/DL)
Diabetes Mellitus Type II
Family history of coronary disease
If Yes To Any:
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 to which questions you answered YES. You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
If No To All:
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
- Start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.
- Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.
-Delay becoming more active if you are not feeling well due to a temporary illness. Or if you are pregnant talk to your doctor before you start becoming more active.
PLEASE NOTE:
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 plan.
DISCLAIMER
Please recognize the fact that it is your responsibility to work directly with your physician before, during, and after seeking fitness consultation. As such, any information provided is not to be followed without the prior approval of your physician. If you choose to use this information without the prior consent of your physician, you are agreeing to accept full responsibility for your decision.
ACKNOWLEDGEMENT
The above screening has been reviewed prior to engaging in any physical activities.
I do hereby further declare myself to be physically sound and suffering from no condition, impairment, or other illness that would prevent my participation or use of the facilities and equipment. I do further hereby acknowledge that I have been informed of the need for a Physicians approval for my participation in exercise/fitness/weight loss activities, or use of equipment. I acknowledge that I have either had a physical examination and have been given my Physician’s permission to participate, OR that I have decided to participate in activities, use equipment and weight loss without the approval of a Physician and do hereby assume all responsibilities.
I, the member or participant understand and agree that fitness activities including weight loss may be strenuous and/or hazardous activities and I should contact a healthcare professional or doctor before beginning any new activities or weight loss program. I am voluntarily participating in these activities and using Evolve Personal Fitness & Gym facilities and equipment with full knowledge of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death related hereto.
In consideration of being allowed to participate in the activities and programs of Evolve Personal Fitness & Gym and use of its facilities and equipment, in the addition of any payment of any fees or charges, I do hereby waive, release and forever discharge Evolve Personal Fitness & Gym , its officers, agents, employees, representatives, executors, and all others from all responsibilities or liabilities for any injuries or damage resulting from my membership or participation in any activities.
I also hereby release all of the above and any others acting in their behalf from any responsibility or liability for any injury of damage to myself or my belongings, including those caused by negligent act or omission, in connection with participation/membership or use of equipment at Evolve Personal Fitness & Gym
INDEMNIFICATION: Member and all heirs, representatives or assigns hereby agree to indemnify, defend and hold harmless Evolve Personal Fitness & Gym and its officers, employees, contractors, agents, successors or assigns from any and all claims for liability against without limitation, including any interest, penalties, attorney fees and expense incurred either directly or indirectly by reason of, resulting from, or associated with this Agreement and/or Evolve Personal Fitness & Gym.
I have read the above statements and acknowledge that the information provided is true and agree to all the terms and conditions of this agreement.
Parent/Guardian Name/Signature if member is under 18
MONTHLY MEMBERSHIP: I understand and agree that my monthly membership dues of $32.99 will be automatically drafted from my credit card or bank account each month. It will bill on the same day of the month that this agreement was created and continue to do so each month starting today for a minimum of 1 months. I understand that my automatic payment plan will automatically renew and continue until canceled by me in writing by sending an email to EvolvePersonalFitness@gmail.com. I acknowledge that I must give 7 days notice in order to allow time for the cancellation to be processed or I may be billed again. I also agree and understand that no refunds will be given if I fail to notify Evolve Personal Fitness, in writing, of my intention to cancel.
I further acknowledge that personal training and gym membership are paid for separately and that cancelling one does not cancel the other. I understand that if I cancel personal training that will not cancel my gym membership, and that I must email notice to EvolvePersonalFitness@gmail.com in order to cancel my recurring monthly gym membership.
Late Payment and Default: Should you default on any payment obligation as called for in this agreement, the entire remaining balance plus any applicable fees shall be deemed due and payable upon demand. You will be subject up to a $25.00 late fee (plus any applicable tax) for any unpaid balances, bank drafts, credit cards or debit cards due to (but not limited to) the following: NSF’s, closed accounts, stopped payments, invalid accounts, declined credit card, lost or stolen credit card, holds on credit card, invalid or wrong credit card expiration dates etc. It is your responsibility to notify Evolve Personal Fitness in writing of any change in your automatic draft payment method 7 business days prior to your draft date. Any returned\declined credit card transactions will be drafted after the initial transaction and will include late fees of $5 if more than 30 days late, and $10 if more than 60 days late. We reserve the right to redraft any past dues amounts and\or service fees at any time without prior notice to you. You grant Evolve Personal Fitness the right to use the account information from any payment method or payments that you have given to redraft any past due amount and\or late fee. By checking this box and signing below I acknowledge and agree to these terms and conditions.
Membership Information: If you have any questions regarding your membership, contact Evolve Personal Fitness & Gym. You will be given and are required to bring the slide card with you when you come to use the facility.
Rules and Regulations: By signing this contract, you acknowledge the rules and regulations governing the conduct of members and guests, and you agree to follow them.
Guests: Member shall be entitled to bring a guest or guests to Evolve Personal Fitness & Gym, but only pursuant to such rules, regulations, fees, schedules and/ or charges for such guest or guests as may then be in force by Evolve Personal Fitness & Gym. Evolve Personal Fitness & Gym reserves the right to limit the number of guests or the number of times any one guest can use Evolve Personal Fitness & Gym facilities and reserves the all rights to exclude any guest whose use of the facilities, in the sole opinion of Evolve Personal Fitness & Gym, would be detrimental to Evolve Personal Fitness & Gym or any of its Members. No guest may use the facilities without “signing in” at the front desk and no guest may use Evolve Personal Fitness & Gym or any of its facilities or activities with- out being accompanied at all times by the member.
Services: We agree to provide you with use of our facilities and all equipment and amenities which are available to you under the terms of your particular membership. We reserve the right to add or delete services, amenities, and hours as reasonably warranted.
Monthly Dues: Monthly dues represent the cost of having use of the facility available to you for a thirty day period. Dues are considered fully earned the first day of any thirty day availability period. Funds must be available on the date of payment and after until such payment clears. You will not have use of the fitness center if you have an outstanding balance. Member agrees to maintain membership for the minimum length of time (term) as stated on this contract. Drafting memberships automatically renew and can be cancelled only after the minimum contractual term has passed by following the cancellation policy in the following paragraph. Cancellation prior to the agreed upon term does not eliminate member’s obligation to continue making monthly payments as stated in this agreement (see health, disability & death exceptions). Member will be responsible for all unpaid balances as well as court costs and legal fees associated with recovering said balances. Prices and membership rates are subject to change.
Buyer’s Representations: You represent that you have not defaulted on any other contractual obligation with us. If you have, we may apply all amount paid on this contract to your past unpaid obligation before processing this contract.
Restriction on Cancellation: If you fail to use your membership and do not use our facilities, you are not relieved of your payment obligation.
CANCELLATION POLICY: Please note all draft memberships will continue on a month to month basis until cancelled by member with a 7 day written notice. Member must send a written notice by email to the following address: EvolvePersonalFitness@gmail.com . All cancels take effect 7 days from the date the email was sent.
IF THE HEALTH SPA GOES OUT OF BUSINESS AND DOES NOT PROVIDE FACILITIES WITHIN 10 MILES OF THE FACILITY IN WHICH YOU ARE ENROLLED OR IF THE FITNESS CENTER MOVES MORE THAN 10 MILES FROM THE FACILITY IN WHICH YOU ARE ENROLLED, YOUR MEMBERSHIP WILL BE AUTOMATICALLY CANCELLED. YOU MAY ALSO FILE A CLAIM FOR A REFUND OF YOUR UNUSED MEMBERSHIP FEES AGAINST THE BOND OR OTHER SECURITY POSTED BY THE HEALTH SPA WITH THE TEXAS SECRETARY OF STATE. TO MAKE A CLAIM AGAINST THE SECURITY, PROVIDE A COPY OF YOUR CONTRACT TOGETHER WITH PROOF OF PAYMENTS MADE ON THE CONTRACT TO THE TEXAS SECRETARY OF STATE. THE REQUIRED CLAIM INFORMATION MUST BE RECEIVED BY THE SECRETARY OF STATE NOT LATER THAN THE 90TH DAY AFTER THE DATE NOTICE OF THE CLOSURE OR RELOCATION IS FIRST POSTED ON THE SECRETARY OF STATE’S WEBSITE.
IF YOUR DOCTOR DETERMINES THAT YOU ARE ILL OR INJURED TO THE EXTENT THAT IN YOUR DOCTOR’S OPINION YOU ARE UNABLE TO USE THE FACILITIES OR IF YOU DIE OR BECOME TOTALLY OR PERMANENTLY DISABLED AFTER THE DATE THIS CONTRACT TAKES EFFECT, YOU OR YOUR ESTATE MAY CANCEL THIS CONTRACT AND RECEIVE A PARTIAL REFUND OF YOUR UNUSED MEMBERSHIP FEE BY EMAILING A NOTICE TO THE HEALTH SPA STATING YOUR DESIRE TO CANCEL THIS CONTRACT. THE HEALTH SPA MAY REQUIRE PROOF OF ILLNESS OR INJURY, DISABILITY OR DEATH.
Assignment of Contract: We reserve full authority to sell, assign or transfer our right to receive payment from you at our discretion.
Waiver and Release: Use of our facilities is at your own risk, and we shall not be liable for any injury or damages resulting from your use of our services and facilities. If you are aware of any health problems, we urge you to see your doctor before using our facilities.
Complete Agreement and Severability: The terms on both sides of this contract constitute the full agreement between you and us, and no oral promises are part of the agreement.
NOTICE TO PURCHASER: 1) DO NOT SIGN THIS CONTRACT UNTIL YOU READ IT OR IF IT CONTAINS BLANK SPACES 2). By signing this contract you certify that you have read, understand and agree to all pages of this contract.
Parent/Guardian Name/Signature if member is under 18
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