Fill out form completely to be contacted for an appointment to make payment arrangements and receive your key fob for gym access. All fields must have an entry. Put "N/A" for fields that do not apply to you.
PERSONAL INFORMATION:
EMPLOYMENT INFORMATION:
EMERGENCY CONTACT:
SPOUSE/CHILD(REN) INFORMATION (IF FAMILY MEMBERSHIP):
What type of membership are you seeking?
MEMBERSHIP INFORMATION:
Do you wish to add tanning? ($5 extra per month per person)
Are you military, Gravette teacher, Gravette student, or law enforcement?
Which payment method will you be using?
Please read each item below and check the box to acknowledge understanding of their meaning. If you have any questions, please contact us for clarity. Failure to agree to terms below will result in denial of membership to our facility.
How many?
If Yes, which?
LIABILITY WAIVER
Wryddle Investments, LLC, d/b/a The Gravette Gym, urges all members to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise class. All exercises, including the use of weights and use of any and all machinery, equipment, and apparatus for exercising shall be at the member’s sole risk and discretion. Member understands that the agreement to use, or selection of exercise programs, methods and types of equipment shall be members entire responsibility, and Wryddle Investments, LLC, d/b/a The Gravette Gym, shall not be liable for any claims, injuries, damages, or actions arising due to injury of member’s person or property arising out of or in connection with use by any member of the services, facilities, and premises of the gym. Member hereby holds Wryddle Investments, LLC, d/b/a The Gravette Gym, its officers, owners, agents, and employees harmless from all claims that may be brought against them by member or on member’s behalf for any such injuries or claims.
MEDICAL AUTHORIZATION
THE UNDERSIGNED, for himself or herself as parent or guardian of any such children and any personal representatives, heirs, and next of kin, HEREBY AUTHORIZE Wryddle Investments, LLC, d/b/a The Gravette Gym, to transport my child and/or ward to a doctor, hospital or other health care facility and to act in my place to obtain medical or hospital treatment.
USE OF IMAGES/NAME IDENTIFICATION
THE UNDERSIGNED HEREBY AUTHORIZE Wyrddle Investments, LLC, d/b/a The Gravette Gym, to use images of himself or herself as parent or guardian of any such children and any personal representatives, heirs, and next of kin, with and without name identification, for Wryddle Investments, LLC, d/b/a The Gravette Gym, publicity, promotional and advertising purposes and release any and all claims and/or rights I and/or my child and/or ward might have as a result.
ACKNOWLEDGEMENT OF RULES AND POLICIES
THE UNDERSIGNED HEREBY ACKNOWLEDGE that Wryddle Investments, LLC, d/b/a The Gravette Gym, has rules and policies in place regarding safety, registration, use of facilities, conduct and others. THE UNDERSIGNED HEREBY REVIEWED all policies currently in place (copies always available upon request). THE UNDERSIGNED HEREBY UNDERSTAND that failure to follow the rules in Wryddle Investments, LLC, dba The Gravette Gym discretion may result in revocation of all privileges provided by Wryddle Investments, LLC, d/b/a The Gravette Gym, without refund of any prepaid fees. THE UNDERSIGNED IS OF LEGAL AGE, HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, AND FURTHER AGREES THAT NO ORAL MODIFICATIONS, REPRESENTATIONS, STATEMENTS, OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.
I HAVE READ and UNDERSTAND THIS RELEASE.
FULL NAME:
DATE OF BIRTH:
ADDRESS:
CITY:
STATE:
ZIP:
E-MAIL:
CURRENT EMPLOYER:
CITY:
NAME OF RELATIVE NOT RESIDING WITH YOU:
PHONE:
SIGNIFICANT OTHER FULL NAME:
DATE OF BIRTH:
PHONE:
CHILD/FAMILY MEMBER NAME:
CHILD/FAMILY MEMBER NAME:
CHILD/FAMILY MEMBER NAME:
CHILD/FAMILY MEMBER NAME:
AGE:
AGE:
AGE:
AGE:
PHONE NUMBER:
