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Online Fitness Agreement


I understand that personal training includes physical movements/exertion as well as an opportunity for strength gain, stress re-education and cardiovascular endurance. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. I am fully aware of the risk and hazards involved. I, my heirs, assigns, and/or legal representative waive and release Climb Chiropractic Sports Health and its teachers from any and all liability and responsibility from any injury, accident, illness, legal and medical fees sustained now or in the future resulting from my participation in any activity. I understand that I am giving up my rights to sue or make any claims of any kind whatsoever against Climb Chiropractic Sports Health and it’s teachers for any personal injury, or property damage/loss. If I experience any pain or discomfort, I will listen to my body and discontinue the activity. I assume full responsibility for any and all damages, which may incur through participation. 

Personal training is not a substitute for medical attention, examination, diagnosis or treatment. Personal training is not recommended and is not safe under certain medical conditions. By signing, I affirm that a licensed physician has verified my good health and physical condition to participate in such a fitness program. If I am pregnant, become pregnant or I am postnatal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to exercise and participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Climb Chiropractic Sports Health and it's instructors. I agree to let Climb Chiropractic Sports Health use my photographs, video, and/or waive any rights of compensation or ownership thereto.

I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of New York.




AUTOMATIC ONLINE PAYMENT AGREEMENT

An automatic recurring payment in the range provided to you electronically, or as described to you by the company representative will be made every month (“Monthly Payment”) for the with monthly renewal of your subscription on a recurring basis after the Initial Term. For example, if your subscription requires a $30 per month payment, and your subscription begins on March 1, the first recurring monthly Payment of $30 will be made on March 1. Your next automatic recurring payment in the amount of $30 would occur on April 1. You will not receive any advance notice of this payment but you will receive post-payment confirmation by email.

You have the right to withdraw your consent to this Automatic Recurring Payment at any time. To cancel your Automatic Recurring Payment, call CLIMB at 315-733-0590. Your request to cancel your Automatic Recurring Payment may take up to 24 hours to take effect.

This Agreement is not transferable and must be agreed to by the person authorized on the company, by calling a company representative and following the authorization process.

AGREEING TO THESE CONDITIONS

By providing my credit, or debit card or bank account information (“Payment Method”), I AGREE that I have read and understand this Automatic Recurring Payment Agreement. In addition, I authorize Climb Chiropractic PLLC to charge the full amount required by my rate plan (once every month or more frequently as described) to the specified Payment Method; and I authorize the financial institution for the Payment Method, specified above to charge or debit my account and remit payment for my subscription to Climb Chiropractic PLLC. This authority will remain in effect until I give notification, as required under this Agreement, to terminate this authorization.

I Agree


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

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

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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