Schedule Appointment with Verticality Pole and Aerial Fitness

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Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Month to Month	x $79.50	$79.50 per month
Total: $79.50	Coupon:

Liability Waiver

I have volunteered to participate in a fitness program provided to me by VERTICALITY POLE AND AERIAL FITNESS (“Trainer”), which may include, but may not be limited to, resistance training and aerobic or cardiovascular exercise. In consideration of Trainer’s agreement to instruct and train me, I do here now and forever release and discharge and hereby hold harmless Trainer and her respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting there from.THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT BELONGING TO TRAINER OR TO MYSELF THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION OR SUPERVISION. I have been informed of, understand and am aware that any exercise program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that any exercise and/or fitness activities involve a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death.I have been advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed. If I have chosen not to obtain a physician’s consent prior to beginning this fitness program with Trainer, I hereby agree that I am doing so solely at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all fitness related activities and/or exercises in which I participate.I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST TRAINER FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS. This form is an important legal document that explains the risks you are assuming by beginning an exercise program. It is critical that you have read and understand this document completely. If you do not understand any part of this document, it is your ultimate responsibility to ask for clarification prior to signing it.

IF SIGNING UP FOR A MEMBERSHIP: This Membership is a contract/monthly draft. You will fill out a paper copy your first visit to the gym and is set on an auto-renewing/auto-draft basis.

By registering for this membership, you agree to pay each month for your membership for the duration of your contract. Please note that this membership **AUTOMATICALLY** renews and charges your card on file.

As a Dues Paying Member you are entitled to cancel your membership at any time after the Initial term of your selected membership by giving the agreed upon written notice from your next bill date (your written notice time frame is in your original contract).

(1) Hand in your Cancellation Form at the front desk, or mail it Registered or Certified US Mail to:

Verticality Pole and Aerial Fitness
314 Broadway STE 102
Paducah, KY 42001

No other methods (verbal, letter, email, etc.) of notice for cancellation shall be valid. Member must submit the request for cancellation a minimum of 30 days before a renewal for cancellation request to be valid.

(2) In order for the cancellation to become effective, member must be in financial good standing; all dues and other financial obligations prior to the effective date of the cancellation must be paid in full.

If initiating a medical freeze, email a signed doctor’s note and we will freeze your membership with no charge.The doctor’s note MUST be on the physician’s letterhead with a clearly stated reason and a date to return to exercise, and have a signature.

Classes and memberships are non-refundable and non transferable. A recurring payment will be charged to your account every month. Call 270.557.7938 for additional information.