||Aquila Fitness Consulting Systems, Ltd. Inc. (“Aquila”)
||1221 Brickell Ave Suite #1060, Miami, FL 33131
|Club Location Name:
||Federal Fitness Center
|Club Address (“Club Location”):
||50 UN Plaza, San Francisco, CA 94102
MEMBERSHIP PAYMENT INFORMATION
Your membership starts TODAY. It is a monthly agreement, and therefore ends when cancelled in accordance with Section 2 below. You are required to pay your membership fee regardless of how long you choose to maintain your membership. Amounts paid are non-refundable subject to the cancellation rights described in Section 2.
Aquila will provide you with a membership card. You agree to pay $15.00 for each lost membership card.
DEFAULT RETURN PAYMENTS
Should you default on any payment obligation as called for in this Agreement, the club will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest, and all costs of collection, including but not limited to collection agency fees, court costs, and attorney fees. You also agree to pay $20.00 for returned check or rejected EFT or RCC (defined in Section 1). If you are paying monthly dues by EFT or RCC, Aquila reserves the right to draft via EFT all amounts owed by you including any and all default return fees and service fees subject to appropriate State and Federal Law.
SECTION 1: PERIODIC PAYMENT INFORMATION
You understand that the minimum term of your agreement is 30 days, unless cancelled in accordance with Section 2(A)(i). You want amounts you owe to Aquila under this Agreement (the "Agreement") to be paid through one of the following (select one):
Recurring charges to your debit card (“Debit”);
Recurring debits to your bank account through the ACH (an "EFT"); or
Recurring charges to your credit card account ("RCC")
Your payment of your first month’s dues will be pro-rated based upon the effective date of the Membership Agreement and collected upon joining the Club. All subsequent payments will be due on the 1st of each month thereafter. Your signature below constitutes your authorization and agreement to the following terms for those debit, EFT or RCC charges. Specifically, you authorize Aquila, on a monthly basis, to charge your above listed credit or debit card account, or to initiate an EFT from the account you designated above or any successor or replacement card or account, for the monthly dues rate indicated above, and any other amounts you owe to Aquila under this Agreement, including any fees, and/or taxes. If your card or account expires or is replaced, you agree to promptly notify Aquila of your new card or account. This authorization will remain in effect until this Agreement is cancelled by you or Aquila pursuant to Section 2.
The amounts charged or debited to your account may vary each month from the amount shown above due to a change in the monthly dues, past unpaid dues and fees, increases in applicable taxes, or other fees and charges that you may owe. For EFT charges only, you understand that Aquila will notify you at least 10 days in advance of any EFT debit that will be more than one time the normal monthly debit amount. Upon your written request, Aquila will notify you if the amount of your EFT or RCC will vary by any amount.
If your EFT or RCC is rejected or returned unpaid for any reason, you authorize Aquila to resubmit it for payment one or more subsequent times in the future. If amounts you owe to Aquila are not paid because an EFT debit or RCC does not go through for any reason, your failure to pay those amounts may result in the suspension or termination of your membership, as described in Section 2(B)(i).
You may stop any EFT (debit to your checking or savings account by ACH or debit card) by notifying your financial institution at least 3 days before the scheduled transfer date.
SECTION 2: TERMINATION & CANCELLATION
2(A) YOUR RIGHT TO TERMINATE:
2(A)(i) Five-Day Cancellation:
You, the buyer, may cancel this agreement at any time prior to the midnight of the fifth business day of the health studio after the date of this agreement, excluding Sundays and holidays. To cancel this agreement, mail or deliver a signed and dated notice, or send a telegram which states that you, the buyer, are canceling this agreement, or words of similar effect. The notice shall be sent to Aquila at Federal Fitness Center / CO Aquila, 450 Golden Gate Ave, San Francisco CA 94102.
2(A)(ii) Cancellation due to Closure or Move of Club Location or Move Your Residence
You are entitled to a cancellation and refund under this Agreement if the Club Location goes out of business, or moves it’s facilities more than 5 driving miles and fails to provide, within 30 days, a facility of equal quality located within 5 driving miles of the Club Location at no additional cost to you. You are also entitled to a cancellation if you move more than 25 miles from the Club Location.
2(A)(iii) Cancellation Due to Death or Physical Inability:
You may cancel this Agreement if you die or become physically unable to avail yourself of a substantial portion of those services which you used from the commencement of the Agreement until the time of disability, with refund of funds paid or accepted in payment of the contract in an amount computed by dividing the contract price by the number of weeks in the contract term and multiplying the result by the number of weeks remaining in the contract term. The buyer or the buyer’s estate seeking relief under this paragraph may be required to provide proof of disability or death. A physical disability sufficient to warrant cancellation of the Agreement by the buyer shall be established if the buyer furnishes to the health studio a certification of such disability by a physician licensed to the extent the diagnosis or treatment is within the physician’s scope of practice. A refund shall be issued within 30 days after receipt of the notice of cancellation made pursuant to this paragraph.
2(A)(iv) 30 Day General cancellation policy:
You may cancel your membership at any time by filling out a cancellation request form and/or stop payroll deduction form (such notice must be given in writing to the Club Location). The notice of cancellation terminates automatically your obligation to any entity to whom Aquila has subrogated or assigned your Agreement. Accordingly, your membership will end 30 days from the date that Aquila receives your notice of cancellation.
Even after your notice of cancellation, you authorize Aquila to charge or debit your account for any amounts you owe under this Agreement up to the date your membership ends and you agree to be bound by the terms and conditions of this Agreement until your membership ends. Notwithstanding any other language in this Agreement, you agree that all rights and obligations of both Aquila and you that are intended to survive cancellation of this Agreement will continue after cancellation and/or the end of your membership, to the extent permitted by law.
2(B) AQUILA’S RIGHT TO TERMINATE:
2(B)(i) Termination for Cause
Aquila may, at its option, terminate your membership due to: (1) failure to properly complete and endorse the Agreement; (2) failure to make timely payment; (3) your monthly EFT/RCC payments being interrupted and your failure to provide an alternative within a reasonable amount of time; (4) failure to follow any Aquila policies, Club Location rules, or the terms of this Agreement; or (5) conduct that is improper or harmful to the best interests of Aquila or its customers. Termination is effective upon the date that Aquila mails you a written notification of termination. You are responsible for all fees incurred up to the date of termination.
2(B)(ii) Termination Without Cause
Aquila reserves the right to terminate your membership for any reason not listed above and not inconsistent with or prohibited by law. Termination is effective upon the date that Aquila mails you a written notification of termination. You are responsible for all fees incurred up to the date of termination.
SECTION 3: WAIVER & RELEASE
You understand that you will not be allowed access to the Club Location unless you read, sign and deliver to Aquila this Waiver and Release. You recognize that participation in the activities offered at the Club Location is strictly voluntary and acknowledge that some of the activities in which you will participate may be of hazardous nature and include strenuous physical exercise or activity. Recognizing this, you hereby certify that, to the best of your knowledge, you do not have any medical, physical, mental, or emotional health condition that would hinder or prevent your active participation in such activities. You agree to complete and sign a Pre-Activity Fitness Profile Form before participating in any exercise activities at the Club Location.
In consideration of your request to participate in the activities offered at the Club Location, you acknowledge and agree to the following:
1) You hereby assume full responsibility for all risk of injury or loss which may result from your participation in the activities offered at the Club Location.
2) You agree to indemnify and hold harmless, release and forever discharge, Aquila and their affiliates and instructors (and their respective partners, officers, agents, employees, and other representatives of any of the foregoing) from any and all acts of negligence and all claims and demands whatsoever, which you, any third person, or any persons acting on their behalf, have or may have against any of said indemnified parties, by reason of any accident, illness, injury or death of any person or persons, or damage to or loss, theft or destruction of any property, arising or resulting directly or indirectly from participation in the activities offered by the Club Location and occurring during said participation, or any time subsequent thereto.
3) You represent and warrant to Aquila and its contractors and instructors that the answers you have given in your Pre-Activity Fitness Profile Form are true and accurate.
4) The terms of this Release will serve as a release and assumption of risk for you and your heirs, executors, and administrators and for all of your family members. If contractors and/or instructors are utilized at the Club Location, they shall be covered by this release without regard to the nature of such contractors’ or instructors’ relationship, if any, to Aquila.
5) Nothing herein shall be construed as a waiver of any rights or benefits, which would otherwise be available under any applicable medical or Worker’s Compensation insurance carried by or for the benefit of the undersigned participant.
6) Aquila reserves the right to exclude anyone from the Club Location for any reason, including but not limited to situations in which such person’s continued use may be dangerous, any inappropriate behavior, or any other violation of rules which may be established from time to time.
SECTION 4: ACCIDENT MEDICAL INSURANCE
PLEASE NOTE THAT AQUILA STRONGLY RECOMMENDS THAT EACH PARTICIPANT HAVE SOME TYPE OF ACCIDENT MEDICAL INSURANCE FOR HIS/HER OWN PROTECTION AND OBTAIN A PHYSICIAN’S RELEASE FOR EXERCISE.
SECTION 5: MEMBERSHIP RULES
You agree to follow all rules and regulations now in force or in the future adopted by Aquila.
SECTION 6: CLUB LOCATION RULES
1) No one may use the Club Location before signing and returning all required member registration forms, including the Membership Agreement and Pre-Activity Fitness Profile Form. Additionally, a membership card is required for access to the facility. All members must have their cards scanned upon entry.
2) No one under the age of eighteen (18) years is allowed on the premises.
3) New members should familiarize themselves with health club equipment with the assistance of the staff trainer.
4) Fitness equipment is used at the member’s and guest’s own risk. Please do not exceed the schedule suggested by the trainer without his/her consultation. Time restrictions may apply to some equipment when the Club Location is crowded, and these restrictions must be adhered to.
5) Free weights must be returned to racks when finished.
6) No smoking, food, or alcohol allowed in the facility. Water and other liquids must be kept in sports bottles, or other appropriately approved containers.
7) No running, jogging, or horseplay.
8) A shirt and soft-soled athletic shoes must be worn on the exercise floor. No belt buckles or studded clothing.
9) No cursing, loud or abusive language.
10) Please read equipment safety and instructional signs carefully before using machines.
11) Use the equipment as it is intended to be used.
12) Insert weight pins fully into weight stacks. Do not use add-on weights or other objects or training aids unless provided by the facility and intended specifically for such use.
13) Keep head and limbs clear of weights and other moving parts. Do not drop weight stacks—return weights to starting position slowly.
14) Do not attempt any repairs or adjustments that are not part of the intended use of equipment.
15) Stop exercise if you feel weak, faint, nauseous, or unduly tired or uncomfortable.
16) Do not leave items in the day-use lockers following your workout. Items will be removed and discarded at member’s risk.
17) Please deposit all used towels into the appropriate receptacle.
SECTION 7: RESERVATION OF RIGHTS
Aquila reserves the right at any time to alter the hours of operation, and the right to amend the cost of, add, modify and/or eliminate any program, facility, activity, class or service of any club, in our sole discretion. Classes and equipment are available subject to demand and may be crowded at peak hours or may be discontinued or times changed if demand fluctuates.
SECTION 8: DELIVERY OF NOTICES AND MAIL
By your signature below, you give express consent to: (1) receive membership communications by text message, e-mail, or other means; and (2) receive marketing communications from Aquila by any means including mail, telephone, pre-recorded message, text message, instant message and other means. You may change your communication privileges by e-mailing to Aquila.
SECTION 9: LIMITATION OF LIABILITY
Unless controlling legal authority requires otherwise, any award by an arbitrator or a court is limited to actual compensatory damages. Specifically, neither an arbitrator nor a court can award either party any indirect, special, incidental or consequential damages, even if one party represented to the other party that they might suffer these damages.
SECTION 10: GOVERNING LAW
To the full extent permissible by law, for purposes of any dispute arising out of this agreement, all parties hereto agree to submit to the sole and exclusive jurisdiction of the State of California.
SECTION 11: WAIVER OF JURY RIGHTS
In any civil action, counterclaim or proceeding, whether at law or in equity, which arises out of, concerns, or relates to this Agreement, and any and all transactions contemplated hereunder, the performance hereof, or the relationship created hereby, whether sounding in contract, tort, strict liability or otherwise, trial will be to a court of competent jurisdiction and not to a jury. Each party hereby irrevocably waives any right it may have to a trial by jury. Any party may file an original counterpart or a copy of this agreement with any court as written evidence of the consent of the parties hereto of the waiver of their right to trial by jury. Neither party has made or relied upon any oral representations to or by any other party regarding the enforceability of this provision. Each party has read and understands the effect of this jury waiver provision.
SECTION 12: SEVERABILITY
If any part of this agreement shall be held invalid, that part shall be deemed excluded from this agreement and the remainder of this agreement shall remain in full force and effect.
SECTION 13: ENTIRE AGREEMENT
The parties acknowledge that this Agreement constitutes their entire agreement. It cannot be amended except in written form executed by both parties.
BY SIGNING BELOW, YOU ACKNOWLEDGE RECEIPT OF: (1) A FULLY COMPLETED COPY OF THIS CONTRACT EXECUTED BY BOTH YOU AND AQUILA AT THE TIME OF THE AGREEMENT’S EXECUTION; AND (2) A COPY OF THE RULES AND REGULATIONS HEREIN.
Aquila Fitness Consulting Systems, Ltd. | 1.800 806 8482 | www.aquilaltd.com
Pre-Activity Fitness Profile
Federal Fitness Center
Federal Fitness Center
50 UN Plaza
San Francisco, CA 94102
Information supplied is strictly confidential
1. Regular physical activity is relatively safe for most people. However, some individuals should check with their personal health care provider before starting an exercise program. The Pre-activity fitness profile form will help us identify possible risk factors that may affect your ability to exercise safely. Keep in mind that the presence of risk factors may not preclude you from beginning an exercise program, but it will assist us in addressing any medical concerns that may cause modifications to your exercise program.
2. All members & clients must complete Pre-Activity Fitness Profile Form to participate in exercise assessment and fitness consultation programs and services. If you require medical clearance take the last page titled “To be completed by personal health care provider” to your physician and have him/her complete that page.
|If you opted for a Complimentary Exercise Assessment Testing please read below before your appointment.
1. Wear shorts, T-shirts and rubber shoes for the Fitness Profile test. Do not wear tights or a one piece top because they make it difficult to obtain accurate skinfold measurements.
2. Drink plenty of fluids over the 24-hour period preceding the test.
3. Abstain from food, tobacco, alcohol and caffeine for 3 hours prior to the test.
4. Avoid exercise or vigorous physical exercise the day of the test. It is best if the Fitness Profile test is the first exercise you perform for the day.
5. Get an adequate amount of sleep (6-8 hours) the night before the test.
6. Notify your fitness counselor if you have recently been ill. The test may need to be rescheduled.
This form is not a substitute for a thorough physical examination, assessment and diagnosis by your physician. It is designed to identify adults for whom physical activity might be inappropriate at this time. Aquila strongly recommends that each client undergoes a medical examination before beginning any exercise programs.
|Date of Birth:
|*Personal Health Care Provider:
! If you answered YES to any of the above questions you will need to obtain a medical clearance. Take the last page titled “To be completed by your health care provider” to your physician and have him/her complete the page.
Release and Waiver of Liability & Indemnity Agreement
IN CONSIDERATION for being permitted to participate in the Lanham Fitness Center Programs (hereafter the “Federal Fitness Center”), professionally managed by Aquila Fitness Consulting Systems, Ltd., “Aquila” for any purpose, including, but not limited to observation, participation in physical activities or using facilities or equipment in any way, I, on behalf of myself, my personal representatives, heirs, assigns, and next of kin, hereby acknowledge, agree, represent, and warrant with respect to any present or future entry into or use of the Lanham Fitness Center that:
1. Immediately upon entering, I will inspect the facilities of the Lanham Fitness Center. I further warrant that remaining in the Federal Fitness Center after such entry for the purposes of either observation, participation in physical activities or use of any facilities or equipment constitutes an acknowledgment that I find and accept same as being safe and reasonably suited for the purposes of such observation, participation or use.
2. I am aware that the Federal Fitness Center has facilities and equipment for activities such as, but not limited to, weight training, walking, stair-climbing, jogging and running, rowing, aerobic activities, personal training, group fitness, and exercise testing. I understand that participation in physical activities and the use of facilities, services, programs or equipment at the Federal Fitness Center involves inherent risks, including but not limited to, death, serious neck and spinal injuries resulting in complete or partial paralysis, heart attacks, and injury to bones, joints, or muscles. I represent that I am voluntarily observing or participating in Federal Fitness Center activities. I hereby assume full responsibility for any risk of bodily injury, death or property damage (whether due to ordinary negligence or otherwise) arising in connection with my observation, participation in physical activities and use of Lanham Fitness Center facilities and equipment.
I declare that I intend to use some or all of the activities, facilities, programs, and services offered by Aquila Fitness Consulting Systems, Ltd. and I understand that each person, (myself included), has a different capacity for participating in such activities, facilities, programs and services. I am aware that all activities, services, and programs offered are educational, recreational, and/or self-directed in nature. I assume full responsibility, during and after my participation, for my choices to use or apply, at my own risk, any portion of the information or instruction I receive. I understand that part of the risk involved in undertaking any activity or program is relative to my own state of fitness or health (physical, mental, or emotional) and to the awareness, care and skill with which I conduct myself in that activity or program. I acknowledge that my choice to participate in any activity, service, and programs of Aquila Fitness Consulting Systems, Ltd. brings with it my assumption of those risks or results stemming from this choice and the fitness, health, care and skill that I possess and use.
I recognize that by participating in the activities, facilities, programs and services offered by Aquila Fitness Consulting Systems, Ltd., I may experience potential risks such as, but not limited to, transient light-headedness, fainting, abnormal blood pressure, chest discomfort, leg cramps, and nausea and that I freely and willingly assume any discomfort, fatigue, or any other symptoms that I may suffer during and after my participation. I understand that I may stop or delay my participation in any activity or procedure if I so desire and that I may also be requested to stop and rest by a supervising employee who observes any symptoms of distress or abnormal response. I further acknowledge and agree that the level of my participation in the exercise program and which exercises to perform must be determined by me, in consultation with my physician, and that the Lanham Fitness Center and Aquila Fitness Consulting Systems, Ltd. are not responsible for the intensity of my participation.
I recognize that exercise is not without some risk to the musculoskeletal system (symptoms such as, but not limited to, sprains, strains) and cardio respiratory system (symptoms such as, but not limited to, dizziness, fainting, abnormal heartbeat, discomfort in breathing, abnormal blood pressure, in rare instances heart attack or stroke). I hereby certify that I know of no medical problem (except for those that I indicated on the fitness profile questionnaire) that would increase my risk of illness or injury as a result of participation in a regular exercise program. I understand that the completion of this form will not result in any type of diagnosis of disease and that it is not intended as a substitute for consultation with my personal health care provider. I must consult my own personal health care provider for any evaluation of my health status. I hereby waive, discharge, absolve, hold harmless and forever release Aquila Fitness Consulting Systems, Ltd., and GSA, its employees, officers, agents, representatives, executors, affiliates, instructors, and all those associated from any and all liability arising out of any accident, injury, or loss sustained by me as a result of activities at or present in the Lanham Fitness Center managed by Aquila Fitness Consulting Systems, Ltd, facilities, activities, programs and services.
Medical Release Form to be Completed by Personal Health Care Provider
If you require a medical release please have your health care provider complete this part. For quicker response you can fax this page to your health care provider.
Your patient, , has applied to participate in the Aquila fitness & wellness program.
We follow the American College of Sports Medicine (ACSM) guidelines for exercise participation. Your patient may be required to undergo the following as indicated by ACSM guidelines:
Physiological tests including:
- Sub maximal graded exercise test (bicycle ergometer)
- Measurements of resting heart rate & resting blood pressure
- Body composition (skinfolds) analysis
- Strength Test; 1RM (Repetition Maximum) arm curl or sit-ups in one minute or maximum amount of push ups Flexibility; sit and reach
Exercise Prescription Including:
- Free Weights
- Cardiovascular Exercise
- Flexibility Exercise
Please complete below:
|Resting Blood Pressure:
|Resting Pulse Rate:
||________ mg/dl (within 12 months)
Please check appropriate category:
Please comment on abnormal conditions identified above and include any relevant medical history.
Medical Clearance (check one): To my knowledge and based upon a current review of the above named patient I, the undersigned recommend:
No Physical Activity. Clearance denied at this time
Progressive Physical Activity:
with the avoidance of:
with the inclusion of:
Unrestricted Physical Activity. There are no conditions or illnesses which would contraindicate his/her participation in an exercise program.
|Name of Health Care Provider:
Signature of Health Care Provider: