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Monthly Membership FORM

Next Level Gym OR Kid Zone

3600 Harrison St, Batesville AR 7250

870-758-0295

Monthly Membership

Initial which membership you are wanting.

**NEXT LEVEL GYM Monthly $69 Gym only 

$89 Classes only

$99 Gym & Classes 

**KID ZONE $49 Unlimited Access 24/7 and FREE DROP OFF during staffed hours Monday-Friday all kids over the age of 4 

Monthly Membership begins at sign up and only stops when a cancellation form is signed

Registration Fee of $35 automatically added to first month 


MONTHLY MEMBERSHIP

I understand I am entering to a monthly membership and my membership will renew every month. I acknowledge that I can cancel my membership anytime but has to be 15 days prior to next month auto-draft


RETURN FEES AND RULES

Any return payments will be charged an additional $25 for a return check fee. I understand that this membership is only for me and I will not let anyone in. I understand that if I am caught breaking the rules at letting someone in I will automatically be charged $25 fee. I understand that if I have someone wanting to try the gym they have to sign a waiver and pay for a membership before entering the gym.

ANY QUESTIONS CALL OWNER MELODY LOPEZ 870-758-0295


Date: May 25, 2025

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Which Membership are you signing up for? *
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Which Membership are you signing up for? *
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Which Membership are you signing up for? *
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Which Membership are you signing up for? *
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Which Membership are you signing up for? *
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Which Membership are you signing up for? *
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Which Membership are you signing up for? *
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Which Membership are you signing up for? *
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Which Membership are you signing up for? *
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Which Membership are you signing up for? *
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
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 Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
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BANK NAME *
ROUTE NUMBER *
ACCOUNT NUMBER *

GYM MEMBERSHIP MONTHLY DRAFT

I understand it is my responsibility to pick up and restack all weights that I used. I also understand if I have a kidzone membership for my child that i will watch him or her and secure their safety after hour. I also understand that I am responsible to pick up the kidzone area after my child is finished playing
Rules of Membership *
Click to customize text box label
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 Information
Which Membership are you signing up for? *
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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