UNLIMITED (AUTO DRAFT)

THIS IS AN UNLIMITED MEMBERSHIP SETUP W AUTO DRAFT.

$100 - Billed Monthly until cancelled

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ChalkDirty CrossFit Liability Waiver (4915)
Waiver and Release of Liability
Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in any physical training regimen.  These risks include, but are not limited to: falls which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, or other people around me, injury or death due to improper use or failure of equipment.  Injury may also result simply from the fact of physical training itself.  By its very nature, physical training seeks to me push beyond my limits in order to produce a physical adaptation by my body.  This requires feedback from me to my trainer regarding what is happening with my body.  Excessive work can result (in rare cases) in exertional rhabdomyolysis.  I should look for signs of excessive soreness, darkened urine, and pain in the kidney areas in the days following a particularly intense workout.  While this type of injury is relatively rare, it can occur due to several factors, including (but not limited to) genetic predisposition or dehydration, that may be beyond the control of my trainer.   I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s).  I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while training with CF CHALKUP/CHALK DIRTY CROSSFIT, either at the 2326 Hibiscus Drive, Edgewater FL location or other locations.
I, the undersigned acknowledge that I have no physical impairments or illnesses that I know of that will endanger myself or others.
Initials:             
Release:  In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities available at CF CHALKUP i.e. CHALK DIRTY CROSSFIT, I, the undersigned hereby release CrossFit and CF CHALKUP i.e. CHALK DIRTY, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties.
      This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees.  If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.  If I am signing on behalf of a minor child, I also give full permission for any person connected with CF CHALKUP i.e. CHALK DIRTY CROSSFIT to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.
Indemnification: The participant recognizes that there is risk involved in the types of activities offered by CF CHALKUP i.e. CHALK DIRTY CROSSFIT. Therefore, the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above-mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless CrossFit and CF CHALKUP i.e. CHALK UP CROSSFIT, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by CF CHALKUP i.e CHALK DIRTY CROSSFIT.
Photo/Video Release: I hereby grant CF CHALKUP i.e. CHALK DIRTY CROSSFIT permission to use my photograph/video image in any and all publications for CrossFit or CF CHALKUP, including web site entries, without payment or any other consideration in perpetuity.
I hereby authorize CF CHALKUP i.e, CHALK DIRTY CROSSFIT edit, alter, copy, exhibit, publish or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images.
I hereby hold harmless and release and forever discharge CFCHALKUP i.e. CHALK DIRTY CROSSFIT from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of on behalf of my estate which may have or may have by reason of this authorization.
I am competent to contract in my own name. I have read this release, and I fully understand the contents, meaning, and impact of this release.
I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights. 
CF CHALKUP, LLC is as known As CHALK DIRTY CROSSFIT

UNLIMITED (AUTO DRAFT) Contract
CHALK DIRTY CROSSFIT
2326 HIBISCUS DRIVE  EDGEWATER- FL- 32141
386-283-6749
# HS13340
MEMBERSHIP AGREEMENT 
Date:__________________________
MEMBERSHIP FEES- (CHECK WHICH APPLIES)
·UNLIMITED MONTH TO MONTHLY ACCESS - $125 PER MONTH             ______________                          
·UNLIMITED AUTO PAY - $100 PER MONTH                            ______________
·DROP IN RATE - $10 PER DAY OR $25 (SHIRT INCLUDED)             ______________
·OTHER*/** -                                                    ______________
*INQUIRE ABOUT OUR MILITARY, FIRST RESPONDER & TEACHER DISCOUNTS
** COUPLES/FAMILY RATES ARE SUBJECT TO A DISCOUNT
Account Charge Authorization    
Credit Card/Debit Card Type________________     CC Number________________________________________
Expiration Date ___________________________             SEC Code_________________________________
I acknowledge that the above account is registered in my name and/or I am
an additional signor on the account and have FULL authority to authorize charge.
Member Signature_________________________________________________ Date: _______________________
LATE PAYMENT/DECLINED CREDIT CARD FEES-
A LATE PAYMENT OR DECLINED CREDIT CARD WILL BE SUBJECT TO A $15 FEE. MEMBERSHIP FEES MUST BE PAID ON OR BEFORE THE FIRST DAY OF THE MEMBERSHIP AGREEMENT ___________ (INITIAL).
MEMBER INFORMATION:
NAME- __________________________________    PHONE NUMBER-________________________________
EMAIL-___________________________________  BIRTHDAY- _______________________________
EMERGENCY CONTACT- ________________________   PHONE NUMBER- ________________________________
1/ 3-DAY RIGHT OF RESCISSION-
NEW MEMBERS ARE ENTITLED TO A (3) DAY PENALTY-FREE CANCELLATION AFTER SIGNING THIS AGREEMENT; EXCLUSIVE OF HOLIDAYS AND WEEKENDS, OF ITS MAKING, UPON THE MAILING OR DELIVERY OF WRITTEN NOTICE TO CF CHALKUP. IF THE AGREEMENT IS CANCELLED WITHIN 3 DAYS, CF CHALKUP WILL REIMBURSE TO THE MEMBER ALL MONIES PAID WITHIN 30 DAYS. TO CANCEL, NEW MEMBERS MUST CALL OR COME IN TO CF CHALKUP AND INFORM THEM OF THEIR WISH TO CANCEL ___________(INITIAL).
2/ CANCELLATION OF MEMBERSHIP BY MEMBER 30-DAY NOTICE:
MEMBERS MAY CANCEL THEIR MEMBERSHIP BY NOTIFYING CF CHALKUP OF THEIR WISH TO CANCEL IN WRITING, EMAIL AND/OR IN PERSON, ANY TIME 30-DAYS PRIOR TO THE FIRST DAY OF THE MEMBERSHIP TO BE CANCELLED. THERE ARE NO REFUNDS FOR MEMBERSHIP FEES, AND CF CHALKUP WILL NOT PRORATE A CANCELLED MEMBERSHIP __________(INITIAL).
·MEMBERS ARE ENTITLED TO THE CANCELLATION AND REFUND OF THE CONTRACT IF CF CHALKUP GOES OUT OF BUSINESS, OR MOVES ITS FACILITIES MORE THAN (5) DRIVING MILES AND FAILS TO PROVIDE, WITHIN 30 DAYS, A FACILITY OF EQUAL QUALITY LOCATED WITHIN (5) DRIVING MILES AT NO ADDITIONAL COST TO THE MEMBER.
·MEMBERS MAY CONTACT THE FLORIDA DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES FOR INFORMATION WITHIN 60 DAYS SHOULD THE HEALTH STUDIO GO OUT OF BUSINESS. 
·THE MEMBERSHIP AGREEMENT MAY BE CANCELLED IF THE MEMBER DIES OR BECOMES PHYSICALLY UNABLE TO AVAIL HIMSELF OR HERSELF OF A SUBSTANTIAL PORTION OF THOSE SERVICES WHICH HE OR SHE USED FROM THE COMMENCEMENT OF THE AGREEMENT UNTIL THE TIME OF DISBILITY, WITH REFUND OF FUNDS PAID OR ACCEPTED IN PAYMENT OF THE CONTRACT IN AN AMOUNT COMPUTED BY DIVIDING THE CONTRACT PRICE BY THE NUMBER OF WEEKS IN THE CONTRACT TERM AND MULTIPLYING THE RESULT BY THE NUMBER OF WEEKS REMAINNING IN THE CONTRACT TERM. THE BUYER OR BUYERS ESTATE SEEKING RELIEF UNDER THIS PARAGRAPH MAY BE REQUIRED TO PROVIDE PROOF OF DISABILITY OR DEATH. A PHYSICAL DISBILITY SUFFICIENT TO WARRANT CANCELLATION OF THE CONTRACT BY THE BUYER SHALL BE ESTABLISHED IF THE BUYER FURNISHES TO THE HEALTH STUDIO A CERTIFICATION OF SUCH A DISABILTIY BY A PHYSICIAN LICENSED UNDER CHAPTER 458,459,460 OR CHAPTER 461 TO THE EXTENT THE DIAGNOSIS OR TREATMENT IS WITHIN THE PHYSICIANS SCOPE OF PRACTICE. A REFUND SHALL BE ISSUED WITHIN 30 DAYS AFTER RECEIPT OF THE NOTICE OF CANCELLATION.   
3/ RULES & REGULATIONS-
MEMBERS WHO DO NOT OBSERVE CF CHALKUP RULES AND REGULATIONS OR WHO ABUSE EQUIPMENT IN ANY FASHION WILL BE ASKED TO LEAVE. THE MANAGEMENT RESERVES THE RIGHT TO TERMINATE THE MEMBERSHIP TO ANYONE WHO REFUSES TO OBSERVE CF CHALKUP RULES AND REGULATIONS ____________(INITIAL).
4/ ASSUMPTION OF RISK-
·SHOULD YOU (THE BUYER) CHOOSE TO PAY FOR MORE THAN ONE (1) MONTH OF THIS AGREEMENT IN ADVANCE, BE AWARE THAT YOU ARE PAYING FOR FUTURE SERVICES AND MAY BE RISKING LOSS OF YOUR MONEY IN THE EVENT THIS HEALTH STUDIO AND/OR THIS BUSINESS LOCATION CEASES TO OPERATE. THIS HEALTH STUDIO IS NOT REQUIRED BY FLORIDA LAW TO PROVIDE ANY SECURITY, AND THERE MAY NOT BE OTHER PROTECTIONS PROVIDED TO YOU SHOULD YOU CHOOSE TO PAY IN ADVANCE. 
I have read all and Understand:
__________________________________________________________       ___________________________
                                                                    Member Signature                                       Date