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This year-long agreement is for a monthly membership to Rising Up Rock Gym at 220 N. State Rd, Medina. 

If members wish to cancel before the year contract expires, there will be a fee of 1/2 of one month's dues. 


I understand if the amount of the debit entry to a my account differs from that of the original authorization, the Rising Up Rock Gym must send the me a written notification of the new amount, at least 10 calendar days prior to debit. I also understand if the Rising Up Rock Gym changes the date on or after the entries are scheduled to be debited from a my account, Rising Up Rock Gym must send the me written notification of the new date no less than 7 calendar days before the date of the first entry affected by the change.

I also understand that I have the right to revoke this authorization and payment process by sending Rising Up Rock Gym a Member Change form at least 3 days prior to the next billing date. 

I Agree
June 12, 2025

First EFT Member Name
First Name*
Last Name*
Phone*
First EFT Member Date of Birth*
Date of Birth
First EFT Member Signature*
Second EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Third EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Fourth EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Fifth EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Sixth EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Seventh EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Eighth EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Ninth EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Tenth EFT Member Name
First Name*
Last Name*
EFT Member Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
EFT Membership Agreement
I agree to allowing Rising Up Rock Gym to process my monthly dues from my checking account or credit card on the 2nd of each month (3% charge for credit card). *
Yes
No
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*
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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