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Welcome to the 99 Family! Please read and sign the waivers below to complete your sign-up.

Membership Agreement & Payment Terms

I apply for membership at the 99 BARBELL LLC at 36 W LIVE OAK AVE, ARCADIA, United States, CA, 91007,  on November 29, 2021 I represent and warrant that I am 18 years of age or older and all facts and information set forth in this agreements are true, correct and complete.

In consideration of being allowed to participate and access at 99 Barbell LLC, hereafter referred to as “the gym”, I undersigned, acknowledge, appreciate and agree that:

A. Membership Options:

All memberships are either Month-to-Month or Pre-Paid Annually

  • Month-to-Month Memberships: $55/ monthly

All Month-to-Month memberships are required to pay for their First and Last month of membership dues plus initiation fee at Sign-Up.

  • Annual Payments $540/ annually

Annual Payments membership are required to pay for the full year in advance. Payment is due at Sign-Up

  • Premium Training Membership

Premium Training Membership are non-refundable and paid monthly.

  • Short term passes $45/ 1 week pass, $75/ one month pass

Short term passes are either 2 weeks or 1 month pass. payment is due at sign-up.

B. Payment Terms:

All payments for memberships and guest fees are collected via auto-debit (i.e., electronic funds transfer) from either an ACH (Automated Clearing House, electronic fund transfer) or debit card. By providing your checking account or debit card information you allow the gym to automatically withdraw dues and fees as they come due each month. If I change financial institutions, I will provide the gym in writing or in person all the information needed for the replacement automatic withdrawal at least ten (10) days before the effective date of the change.

  1. Month-to-Month Payments:Under this option, members must pay the First and Last fee plus initiation fee today upon signing this contract. All fees paid are non-refundable.
  2. Annual Payments:Under this option, members must pay for the full term year at sign up. Payments are non-refundable and noncancellable after 2 business day of signing this agreement.
  3. Premium Membership: Under this option, members must pay in full and all fees paid are non-refundable or transferable. 
  4. Short Term Passes: Under this option, members must pay in full and all fees paid are non-refundable or transferable.

C. Cancellations:

Members have the right to rescind Annual contracts membership only within two (2) business day after signing this Contract. Upon such rescission the member will receive a full refund of all monies paid, including initiation fees. All cancellation must be received either in person or in writing and e-mailed to 99barbell@gmail.com.

All month-to-month membership are non-refundable once purchased

  1. Month-to-Month memberships: Under this option, members can cancel their membership no later than fifteen (15) day before their billing date. For example, if the member’s billing date is on June 15th, the member must notify the gym to cancel their membership no later than June 1st for the cancellation to be effective. Cancellation received after the 1st will not take effect until the following month or in this case July. Please ask our front desk if you have questions regarding this term. The gym does not offer refunds or partial refunds for membership fees paid, and the gym will not prorate a cancelled membership. All month-to-month fees paid are non-refundable.
  2. Annual Contract Memberships:Under this option, members have two (2) days after signing this agreement to rescind their annual paid membership. If members cancel their membership within the three (3) days rights of rescission, the gym will refund all monies paid including initiation fees.
  3. Premium Membership: Under this option, members can cancel their membership anytime before the billing date. For example, if the member's billing date is June 15th, the member must notify the gym to not renew their membership any time before June 15th. If request to not renew is received after June 15th, the request will not take into effect until the following billing cycle. Please ask our front desk if you have more questions regarding these terms.  The gym does not offer refunds or partial refunds for membership fees paid, and the gym will not prorate a cancelled membership. All premium fees paid are non-refundable. Member are able to downgrade to general membership by paying first and last of the general membership fee. At any given time memebrs are also able to switch back to premium membership. Please notify our front desk for more detials.
  4. Short Term Passes: Under this option, all fees paid are non-fundable and non-transferable.

D. Other Fees & Dues:

  1. Late Payment & Declined Credit Card Fees: A $15 late payment will be due and payable for payments received 5 day after the billing date. Membership fees must be paid on or before the billing date. Members who are not current will not be granted access to the facility.
  2. Right to Modify Dues: Members with Month-to-month Membership may have their dues increased at any time. We will inform members of increase dues at least 30 days before the billing date.

E. Freeze Policy for Memberships

      Members in good standing with all fees paid and are current on monthly or prepaid dues are eligible to freeze their accounts. A notice for freeze must be given to the gym in person or via e-mail to 99barbell@gmail.com at any given time.

  1. Month-to-Month Memberships: Under this option members may put their membership on hold, in one calendar month increment for a fee of five ($5) per each month on freeze.
  2. Annual Contract Membership: Under this option, members may put their membership on hold for up to 3 months max and your commitment period and obligation will be extended for the amount of time your membership was on freeze. No further dues will be collected during members approved freeze and their rights to access the gym during the freeze will be suspended
  3. Premium Memberships: Under this option members are not eligible to freeze account. Training sessions must be used within 45 days of initial billing date.
  4. Short Term Passes: Under this option members are not able to freeze account. Short term passes will expire once the paid days are up.

I Agree

Facility Rules and Regulation

A. Facility Hours & Access

Members will have access to the facility during operating hours.

Gym Operating hours:

Monday - Friday: 6:00am – 9:00pm

Saturday: 7:00am – 5:30pm

Sunday: 6:00am – 5:30pm
 

Door Access Hours: 
(Unstaffed hour with entry granted via automatic Door Access)

Monday – Friday: 6:00am - 9:30am

Saturday – Sunday: 7:00am - 5:30am

Hours May Change Without Notice

 

Gym Office Hours:
(Staffed hours)

Monday - Friday: 9:30am - 9:00pm

Saturday / Sunday: 10:00am – 5:30pm

Hours May Change Without Notice

99 Barbell LLC reserves the right to change operating hours at its sole discretion without any effect to this agreement.

 

B. Facility Access

Members will be granted access via Automatic Door Access Monday through Sunday from 5am to 10am.

Please refer to the Door Access Waiver below for full details. Member must read and sign the Door Access Waiver to be granted entry during Door Access Hours.

  • 99 Barbell Member must use I.D. Key Tag for admittance into the facility.
  • D. Key Tag may not be shared and anyone found sharing will have their membership revoked.
  • A $3 fee will be charged to replace a lost or damaged I.D. Key Tag.

C. Facility COVID-19 Guidelines

We will continue to follow the guidelines below to ensure the safety of our members. We will notify members once these rules have been lifted. Your safety is our top priority and we have taken these steps to ensure your safety is met.

  • All members will have to reserve appointments to use the facility.
  • An appointment consists of a 90-minute block and is limited to 20 patrons
  • Training appointments can be booked through our Rhinofit app and can be booked as far as 1 week in advance.
  • Facemask will be required inside the gym at all times regardless of vaccination status.
  • All patron must be fully vaccinated to be allowed indoor. Non-vaccinated patrons will be able to train outside.
  • Each person will be given their own cleaning kit to sanitize and wipe down equipment after use. Make sure to return the kit and dispose of the used towel in the towel bin by the exit before leaving.
  • You will receive an email & text reminder 3 hours before your appointment time. If you need to cancel, you will be able to cancel through the app.

D. Limited Availability

      99 Barbell LLC may close its Facility for seminars, certifications, maintenance, selected holidays and other hours based on municipal requirements. 99 Barbell LLC may delete, change, discontinue, repair, or replace any part or all of the Facility without any effect on this Agreement. 99 Barbell LLC will not be responsible for refunding any membership fees paid, including advance payments up to 12 months. All membership fee paid are non-refundable, non-transferable, and noncancellable.

E. Limited Use

      If you know or should know you have a problem that might prevent you from using the gym (i.e., medical or family emergency, business travel, vacation, etc…) and you sign this Agreement, you agree that your membership is limited accordingly. However, because this is your choice, you must still pay your monthly dues as if you could use the Facility; there will be no carry-over of monthly dues into subsequent months for any time unspent using the Facility in a previous month. See our Freeze Policy for Term Memberships and our Cancellation Policy for other options.

F. Rules and/or Regulations

Members who do not observe the gym rules and regulations or who abuse equipment in any fashion will be asked to leave. The management reserves the right to terminate the membership of anyone who refuses to follow any of 99 Barbell LLC rules or regulations. Not all rules and regulations are listed in this agreement. The gym reserves the right to add, change or remove rules, conditions of membership, opening and closing hours, and all services and facilities offered by the gym.

99 Barbell Gym Rules & Regulation

To keep our facility clean and accessible for everyone, please make sure to read our rules.

  • For the safety of our members, facemask will still be required while training in doors.
  • If you don’t feel well please stay home. If you have been in contact with someone who may be positive of COVID-19 please self-quarantine and do not come to the gym. Please seek medical attention as soon as possible.
  • Wash your hands frequently and please use the hand sanitizer station located by the door on your way in and on your way out.
  • Each person will be given their own cleaning kit to sanitize and wipe down equipment after use. Make sure to return the kit and dispose of used towel in the towel bin by the exit before leaving.
  • Respect the facility and pick up after yourself.
  • We offer different types of weight plates: Calibrated Plates, Bumper Plates, and Cast Iron Plates. Please do not mix the plates. Bumper with bumper, calibrated with calibrated and cast iron with cast iron.
  1. We have a variety of high-quality expensive barbells and in order to maintain the longevity of our equipment, we ask for members to follow our rules regarding our barbells and their usage. Each barbell is labeled and marked.
  • Power Bars:Use for Squat, Deadlift, and Bench
  • Deadlift Bars:Strictly Deadlift ONLY
  • Squat Bars (55lb):Squat, Bench, Deadlift
    Please do not use any of the barbells listed above for Olympic weight lifting, rack pulls, t-bar rows, or any other lifts that are not listed above.

2. Black Olympic Barbell with 99 Barbell Caps may be used for everything. All other specialty bars have their specific usage and purpose. Please ask our staff if you are unsure of how to use the bars.

  • We have added straps to our Power Racks to prevent bars from bending when barbells are dropped due to missed lifts or mishaps. If barbells are bent due to the negligence of the member, the member will be required to pay for the bar. You bend, you pay.
  • Please lift safely and always ask for someone to spot if needed.
  • Cardiovascular equipment use is limited to 20 minutes during peak hours.
  • Please do not use weights on the cardiovascular machines.
  • Members are required to be fully clothed and have closed-toe shoes at all times. If members choose to be barefoot, we are not responsible for any injuries that may occur due to the members’ negligence.
  • Members are not allowed to be topless inside the gym. This is for hygienic purposes and to keep our facility clean.

G. Lost Articles

      99 Barbell LLC assumes no responsibility for lost or stolen articles. Lost and found articles not claimed after 30 days will be donated to charity or thrown away.

H. Prohibited Activities

      Alcohol, drugs (including steroids), and smoking are prohibited within the Facility. Member agrees to not use the Facility or engage in any activity at 99 Barbell LLC while under the influence of drugs, alcohol, or medication that may impair the member.

I. Conduct

      99 Barbell LLC is committed to the health, safety, welfare of each of its members and staff and will not tolerate unreasonable, threatening, obscene, harassing, indecent, or illegal behavior. The gym has the right to judge behavior and respond accordingly. This right includes, but is not limited to, termination of membership without refund of any member engaging in unacceptable behaviors.

J. Damages

Members shall pay for any damages to 99 Barbell LLC property or equipment(s) which results from the willful or negligent conduct of a member or member’s guest.Please report any injury, broken or damaged equipment immediately to staff on duty.

  • If at any given time you are unsure of how to operate the equipment inside the facility, please don’t hesitate to ask one of our staff members during staffed hours. They will be more than happy to assist you

I Agree

Door Access Waiver

Participant release of liability and assumption risk agreement. Please read before signing. In consideration of being allowed to participate and granted door access at 99 Barbell LLC, hereafter referred to as “the gym”, I undersigned, acknowledge, appreciate and agree that:

  1. Door access is only available to active 99 members only. If I fail to make payments on my membership, my door access privileges will be suspended until my account is reconciled.
  2. I agree that improper authorized use of the facility may result in member suspension or cancellation. I agree to not let anyone use my key tag for any reason, and I agree to report any situation that appears to be card sharing to the gym staff. A security “Tailgate” system has been installed to monitor and record instances of “tailgating”. I understand that one act of card sharing will result in immediate membership suspension or termination. A $50 penalty fee will also be charged to my account. Additionally, I recognize this is a violation, and personally take on any and all legal liability should injury occur, to your unauthorized guest(s). The gym reserves the right to suspend or cancel rights, privileges and membership of any members whose actions are detrimental to the use, safety, and enjoyment of the facility.
  3. I understand that if I’m planning on bringing in a guest to the gym during Door Access Hours it is my obligation to contact the gym a day in advance during office (staffed) hours. If I’m unable to contact the gym during office (staffed) hours, it is my responsibility to notify the gym via email or text that I will be bringing a guest and attach the guest’s driver license and payment method. The $15 Drop-In FEE (reduced exclusive rate for 99 members) can either be paid via Venmo (Barbell99) or charged directly to their account.

I understand and am aware that there will be no supervision or assistance during Door Access Hours. (Monday through Friday from 6am to 9:30am and Saturday and Sunday from 6am to 10:00 am. All hours (Door Access, Office and Gym) hours are subject to change by the sole discretion of the gym. I am aware that if I get injured, become unconscious, suffer a stroke or heart attack or any other medical emergency or event that there will likely be no one to respond to my emergency, and the gym has no duty to provide assistance to me while I’m at the gym during Door Access Hours. I understand that even though the gym is fully equipped with surveillance cameras, these records, are not monitored continuously; help will not be available during Door Access Hours. However, a first aid kit and emergency alarms are located in the facility that, when activated, will alert emergency services. In addition, alert pendants will be available that, when activated will connect to 911.

I voluntarily assume the risk of injury, accidents, death, loss, cost of damage to my person or property which might arise from my use of the gym, and I agree to hold harmless and release the gym and all affiliated corporations, and its officers, directors, board members, agents, employees, representatives, executors, and all others from any and all liability. I, for myself, my heirs, personal representatives, or assigns, do hereby release, waive, discharge, and covenant not to sue all of those mentioned and any others action on their behalf from any responsibility or liability for any personal injury, accidents or illnesses (including death) to myself, and property loss arising from my participation in any activities or the use of any equipment at the gym during non-staffed hours.

I certify that I have read and understand all the terms of the gym agreement and agree to continue to abide by all of the terms of this agreement.

PLEASE UNDERSTAND THAT THE GYM HAS THIS STRICT POLICY TO PROTECT OUR MEMBERS AND OUR BUSINESS LIABILITY. MEMBERS WHO HAVE NOT SIGNED THIS WAIVER WILL NOT BE GRANTED DOOR ACCESS.

I Agree

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

 

      99 Barbell Fitness (“the Gym”) has put in place preventative measures to reduce the spread of COVID-19; however, the Gym cannot guarantee that you will not become infected with COVID-19. Further, attending the Gym could increase your risk of contracting COVID-19.

      By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk and I may be exposed to or infected by COVID-19 by attending the Gym and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Gym may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Gym employees, volunteers, and program participants and their families.

      I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the Gym or participation in Gym programming (“Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the Gym, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Gym, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Gym program.

I Agree

Photography/Video/Name Release

Participants involved in any activities offered by 99 BARBELL FITNESS may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the 99 BARBELL LLC website or in any editorial, promotional or advertising material produced and/or published by 99 BARBELL LLC. Participants will be required to book appointments online through our app to train at the facility. The online system will show the participants full name for the appointment time booked. The undersigned hereby grants 99 BARBELL LLC the right to use their name. The undersigned waives the rights to inspect or approve such materials created and/or used by or on behalf of 99 BARBELL LLC pursuant to this release. The undersigned understands that the use of their name will be primarily for the purposes of showing the appointment occupancy and not for advertising purposes. Participants release 99 BARBELL LLC, its officers, employees, agents, assigns, successors and licensees from any claims that may arise therefrom, including but not limited to any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright.

I Agree

Waiver and Release of Liability

  Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s).

  I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under the direction of 99 Barbell LLC. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others. I acknowledge that there may be an animal(s) present in the facility and I waive all rights to all claims for liability and cause(s) or actions that may arise due to the animals in the gym, including allergies, aggressive pet(s) and or any other incidents that may occur due to the presence of the animals in the facility.

 

 

Release

In consideration of the above-mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by 99 Barbell LLC, I, for myself, my heirs, successors, personal representatives or assigns, hereby release, waive, discharge, and covenant not to sue 99 Barbell LLC, its directors, officers, employees, volunteers and agents from any and all liability, from any claims including the negligence of resulting in personal injury, accidents, or illnesses (including death), and property loss arising from actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, classes, observation, and use of facilities, premises, or equipment. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with 99 Barbell LLC to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and/or surgical care for the myself and or the child and to transport myself and or the child to a medical facility deemed necessary for the well-being of myself and or the child.

 

Indemnification

The participant recognizes that there is risk involved in the types of activities offered by 99 BARBELL LLC. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless 99 BARBELL FITNESS, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by 99 BARBELL FITNESS, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by 99 BARBELL LLC.

 

Signature

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.

November 29, 2021

 


 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
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 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 Health Questionnaire
Do you Smoke?*
No
Yes
Do you Drink Alcohol?*
No
Yes
Do you Take Prescription Medication?*
No
Yes
Do you Have Back, Knee, or Shoulder Pain?*
No
Yes
Do you Have any Previous Injuries or Surgeries?*
No
Yes
Do you High Blood Pressure, Asthma, Diabetes, or a Heart Condition?*
No
Yes

Do you have any Other Health Conditions?
Are you signing as a parent or guardian?*
No
Yes
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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