6009 - 86 Street Edmonton, Alberta T6E 2X4

T: 780.468.6560

www.powerhousegym.com

MEMBERSHIP APPLICATION

Membership #  

Client Information

Name:{First Name} {Last Name}                                                     
Date of birth:{Birth Date}
Address:{Street Address}
City:{City}
Province:{State / Province}
Postal Code:{Postal Code}
Phone Cell:{Phone}
E-mail:{Email}                          
Driver’s licence #:
Emergency contact person:  
 
Referred By:  

Terms of Membership

1. 1. This agreement represents the complete understanding between the member and the No representations written or oral, other than those contained within this agreement are authorized by or binding upon the club.
2. 2. The term of this agreement is __________ Monthly dues for the term of this agreement shall be
3. 3. The member is obligated to pay monthly maintenance fees regardless of whether or not the member actually uses the club.
4. 4. Membership fees are not refundable.  Memberships are non-proprietary, non-refundable and non-transferable.
5. 5. Members may bring guests only in accordance with the club’s rules and r Members shall be responsible for the conduct of their guests and the payment of all charges incurred by those guests.
6. 6. The member may terminate his or her membership after expiration of the term set forth above by notifying the club in writing 60 days prior to the termination date and paying all amounts then owed to the club in full. Notice of termination may be given in writing by registered mail or by completing forms at the club.
7. 7. Unless the member terminates his or her membership as set forth in the preceding paragraph, the membership will be automatically renewed on a month to month basis at the expiration of the term set forth above. The member will be obligated to pay monthly dues regardless of whether he or she uses the club facilities, until 60 days after the club has received written notice of termination.
8. 8. Management of the club may suspend or cancel the rights, privileges or membership of any member whose actions are detrimental to the enjoyment of the club facilities by other members.
9. 9. Club management may from time to time, change the rules and regulations governing the operations of the Notice of these changes will be made available to members through normal means of communication.
10. 10. The member acknowledges and accepts the risks inherent in the club services and By use of the club facilities and services, the member hereby voluntarily assumes the risk of injury (including sprains and strains), death, loss, cost or damage to his or her person or property which might arise from the use of club services or facilities. The member acknowledges that the possibility of certain unusual changes during exercise does exist. They include: abnormal blood pressure, fainting, disorders of the heart beat and very rare instances of heart attack. The member understands and accepts all responsibilty for all risks of the foregoing. The member, his or her heirs, executors or representatives, hereby release the club from all claims or liabilities for personal injury or property damage of any kind sustained by the member while on the premises of the club except for injuries or damage directly caused by willful misconduct of the office employees or agents of the club. Member hereby certifies that he or she is in good physical health and is able to undertake and engage in the physical exercise or activities in which he or she chooses to participate.
11. 11. The purpose of this agreement is to insure that the member understands the duties and responsibilities of the club This is a legally binding agreement and if it is not understood by the member, he or she should consult an attorney of his or her choice
12. 12. TERM AGREEMENT
    Member has contracted for an initial membership of at least 4 months or more. Member’s obligations to seller are set forth in this agreement generally or as specificly             noted or excluded.

ANNUAL ENHANCEMENT FEE - July 15 of $39.00 + Tax

Member Signature 

I hereby apply for membership at Powerhouse Gym.
I certify that I have read and understood the terms of this agreement as well as the club rules and regulations and agree to abide by such rules and regulations. POLICY: NO REFUNDS, NO TRANSFERS
All valuables will be my responsibility and left and stored at my own risk.

Contract begins 

Contract ends

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    DAY      MONTH       YEAR

 REPRESENTATIVE OF POWERHOUSE GYM                                                                                     

Membership Information

1.    Administration fee:     0
2.    24 Hour Key Fob $0
3.    Membership Fee $ 0
4.    Tax $ 
      
PAYMENT PLAN

MEMBER’S SIGNATURE 

(parent or guardian if individual is under age of majority)

I (we) acknowledge that I (we) have read and understood all the provisions contained in the terms and conditions of the pre-authorized payment authorization and that I (we) have received a copy.    If funds are not available, a $20 fee will be applied to each denied transaction.

Signature: 

Date:  

White Copy - Powerhouse Gym  Canary Copy - Customer