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Fouche Health and Fitness LLC ("Reach Athletics")  Liability Form

PLEASE INTIAL EACH SECTION

MEMBER / PARTICIPANT ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF REACH ATHLETICS, OR IT’S EMPLOYEES, CONTRACTORS, OFFICERS, OR OWNER/S... PARTICIPANT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER PARTICIPANT PARTICIPATION IN THE PHYSICAL ACTIVITIES.

  

MEMBER/PARTICIPANT FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A MEMBER, SLIP AND FALL BY MEMBER, OR AN UNKNOWN HEALTH PROBLEM OF MEMBER. 

  

MEMBER/PARTICIPA NT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES, MEMBER AFFIRMS THAT MEMBER IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES.   

  

MEMBER/ PARTICIPANT ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND MEMBER AGREES THAT IT IS THE RESPONSIBILITY OF MEMBER TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF PARTICIPANT TO TAKE PART IN  ACTIVITIES. 

  

NEGLIGENCE OF EMPLOYEES, VOLUNTEER ASSISTANTS, INDEPENDENT CONTRACTORS OF "REACH ATHLETICS", NEGILIGENT MISUSE OF THE FACILITY OR EQUIPMENT OF "REACH ATHLETICS", FALLING OFF OR IMPACTING AGAINST THE IMPACT SURFACE, FLOORS OR ANYTHING ELSE; ROPE ABRASION, ENTANGLEMENT OR OTHER ACTIVITIES OCCURING ON THE PREMISES; CUTS OR ABRASIONS RESULTING FROM ANY CAUSE WHATSOEVER; FAILURE OF THE EQUIPMENT, WHETHER INSIDE OR OUTSIDE; PERSONAL HEALTH PROBLEMS; WHETHER MENTAL OR PHYSICAL; NEGLIGENCE OF OTHER PARTICIPANTS; VISITORS OR OBSERVERS OR PERSONS WHO MAY BE PRESENT IN OR AROUND THE FACILITY; AND/OR NEGLIGENCE OR LACK OF ADEQUATE TRAINING OF ANY PERSONS WHO SEEK TO ASSIST WITH MEDICAL OR OTHER HELP EITHER BEFORE OR AFTER ANY INJURY OR DAMAGE MAY OCCUR

MEMBER/PARTICIPANT ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES.   

 

MEMBER/ PARTICIPANT UNDERSTANDS PHOTOS OR VIDEO MAY BE TAKEN DURING THE COURSE OF MY INVOLVEMENT IN THIS EVENT, WHICH MAY BE USED FOR PROMOTIONAL PURPOSES FOR REACH ATHLETICS AS WELL AS OTHER BUSINESS ENTITIES OF FOUCHE HEALTH & FITNESS  LLC. PHOTOS AND VIDEOS MAY BE USED BY REACH ATHLETICS FOR FINANCIAL GAIN AND FOR PROMOTING PRODUCTS AND SERVICES OF REACH ATHLETICS LLC. 

  

MEMBER AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS. 

  


Date: June 13, 2021

First Member's Name

First Name*

Middle Name

Last Name*

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

First Member's Signature*
Second Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Third Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Fourth Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Fifth Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Sixth Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Seventh Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Eighth Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Ninth Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Tenth Member's Name

First Name*

Middle Name

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

Member'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 Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

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

Age *
$169 Month to month membership
$1799 Prepay For 12 Months
$299 Onboarding Package- 2 personal training sessions, nutrition consultation, InBody Scan & first months classes (required for new members)

*All Memberships Auto-Renew

AUTOMATIC PAYMENT AUTHORIZATION: I, the Reach Athletics member, hereby authorize Fouche Health and Fitness LLC to charge to my credit or debit card for the above checked amount.

Any and all payments due to Reach Athletics as indicated above. I, the Reach Athletics member, further authorize my credit card company or back to make payment(s) to Reach Athletics by the method(s) indicated above and to post it on my account.

For Billing Questions: Please email dana@reachathletics.com

Automatic month-to-month: This month-to-month program is considered active and ongoing until cancelled as described in the cancellation policy. All memberships auto renew at the initial rate and agreement. Cancellation Policy: Reach Athletics memberships are month to month (unless otherwise noted) member must give notice of cancellation by email to dana@reachathletics.com at least 14 days from the above stated debit date. Please note...even if you notify your instructor, you are still required to send an email for cancellation. Save  record of this email to serve as your cancellation receipt. Fouche Health and Fitness LLC and Reach Athletics reserve the right to change location, schedule and times without notice.  I certify that I have fully read and understand the terms of this agreement and will comply with the contents herein and those terms & conditions displayed on the Reach Athletics website. 

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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