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Online Membership Enrollment Form


Welcome!

All Participants Must Agree to the Vermont Play Smart Play Safe Requirements & Current State of Vermont Guidelines in regards to Covid-19.

Members and guests must clean equipment before and after use.

Members and guests must follow instructions given by EDGE Employees.


Membership Agreement

A membership may be placed on hold due to injury, illness or travel. Freezes/membership suspensions may be done in monthly increments for one month or more. All membership freezes/suspensions must be done via email, via form on edgevt.com or in person with a Membership Director but are not complete until a confirmation email has been received. Freezes come off automatically. It is the member’s responsibility to contact a Membership Director for a freeze/suspension extension. 

I (we) agree on the membership rates and level listed.

SimplePay memberships continue indefinitely until cancelled by the member with written notice to a Membership Director. Your account (checking account or credit card) will not be billed for the following month once cancellation notice is given. 

Prepaid memberships are non-refundable after 3 business days.

Membership includes use of all available EDGE location. Locations and offerings are subject to change.

I (we) understand that violation of club policies/member code of conduct may result in membership cancellation without refund.

I (we) understand that The Edge may make changes to offerings and programs.

I (we) agree to reimburse The Edge for charges not honored plus bank and penalty charges, as well as responsible for collection costs and attorney fees for any sums due under this contract.

I (we) agree to notify The Edge of any billing errors within 30 days


Facility Use By Children

All children under the age of 14 must be within an arm’s reach of a parent/guardian or supervising adult (18+) while in EDGE facilities.

Children under the age of 14 are not permitted in the fitness center or group exercise studios unless they are with a specific EDGE program for children.


Release of Liability

In consideration of being allowed to participate in any way in the Sports & Fitness Edge, Inc. program, membership, related events and activities, the undersigned acknowledges, appreciates and agrees that:

The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases’ or others and assume full responsibility for my participation; and,

I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest employee or volunteer immediately; and,

I, for myself and on behalf of my heirs, assigns, personal representatives and next kin, hereby release and hold harmless Sports and Fitness Edge Inc. d.b.a. The EDGE, their offices, employees, and other participants, sponsoring agencies, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releases”), with respect to all and any injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the release’s or otherwise, to the fullest extent permitted by law. This waiver also includes any negligence associated with the presence of or transmission of any bacteria, viruses, or infectious diseases.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

Today's Date: November 21, 2024

 




First Participant's Name

First Name*

Last Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
First Participant's Signature*
Second Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Third Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Fourth Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Fifth Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Sixth Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Seventh Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Eighth Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Ninth Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
Tenth Participant's Name

First Name*

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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
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

First Name*

Last 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.


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

Employer *

​Health Readiness Questionnaire

​ 1. Has your doctor ever said you have heart trouble?*
No
Yes
2. Do you frequently have pains in your heart and/or chest?*
No
Yes
3. Do you often feel faint or have spells of severe dizziness?*
No
Yes
4. Has a doctor ever said your blood pressure was too high?*
No
Yes
​ 5. Has your doctor ever told you that you have a bone or joint problem such as arthritis that has been aggravated or might be made worse with exercise?*
No
Yes
6. Is there a good physical reason not mentioned here why you should not follow an activity program even if you wanted to?*
No
Yes
​ 7. Are you over age 65 and not accustomed to vigorous exercise?*
No
Yes
The EDGE offers Tele Nutrition which is covered 100% by most insurance companies. Would you like a member of The EDGE preventative care team to check your insurance for pre-approval?*
No
Yes

Insurance Provider

Insurance ID Number
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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