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Next Level Fitness – 1 YEAR CONTRACT FORM

3600 Harrison St, Batesville, United States, AR, 72501-8820, 870-758-0295

1 Year Contract Membership

Monthly Total $49 FOR GYM ONLY, $69 CLASSES ONLY, OR $79 GYM & CLASSES PLUS TAX

1 year membership starts the day you sign form

Registration Fee $35 automatically added to first month 


RETURN FEES AND RULES

Any return payments will be charged an additional $25 for a return check fee. I understand that this membership is only for me and I will not let anyone in. I understand that if I am caught breaking the rules at letting someone in I will automatically be charged $25 fee. I understand that if I have someone wanting to try the gym they have to sign a waiver and pay for a membership before entering the gym.

ANY QUESTIONS CALL OWNER MELODY LOPEZ 870-758-0295


I authorize LOPEZ RENTALS LLC DBA NEXT LEVEL GYM to charge my bank account for the package membership I have chosen on the day I joined the gym and every month for 12 consecutive months. After one year the payments will continue unless a cancel contract form is filled out to stop payment by no later than the 15th of the month.


Any return payments will be charged an additional $25 for a return check fee. I agree to the terms and conditions to this 1 year contract agreement to paying my contract for the 1 year by charging the amount stated for every month. ANY changes to this contract will begin a new one year contract on the date of the change. To get out of this contract, 90% of remaining contract value has to be summited along with a cancellation form. This must occur by the 15 th of the month in order to avoid bank draft for following month. I understand nonpayment can be sent to collection at any time. I also agree to not dispute this recurring bill with my bank so long as the transactions correspond to the terms indicated in this authorization form. THIS IS A NON-TRANSFERERABLE CONTRACT.


I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

I understand that this membership is ONLY for me and if I let anyone without authorization I will automatically be charged $25 for breaking the rules. This fee is for breaking the rules and getting caught letting someone in without approval


Date: May 4, 2025

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Which membership are you signing up for? *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Which membership are you signing up for? *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Which membership are you signing up for? *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Which membership are you signing up for? *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Which membership are you signing up for? *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Which membership are you signing up for? *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Which membership are you signing up for? *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Which membership are you signing up for? *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Which membership are you signing up for? *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Which membership are you signing up for? *
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Click to customize section title

BANK NAME *

ROUTE NUMBER *

ACCOUNT NUMBER *

GYM MEMBERSHIP DRAFT MONTHLY

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Which membership are you signing up for? *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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