The Scrapyard LLC.,
Access & Liability Waiver
*A one-time $25 fee will be required upon submission of this form.

Primary Membership-holder Information (Required)

First Name of Participant

Last Name of Participant

Date of Birth of Participant

Phone # of Participant

Secondary Membership-holder Information (For Couples)

First Name of Participant

Last Name of Participant

Date of Birth of Participant

Phone # of Participant

I (we) understand to not allow access to The Scrapyard facilities to any non-members without prior consent/approval of The Scrapyard LLC staff, as doing so may jeopardize my (our) membership status without additional warning, and trespassing charges may be filed against any non-member individual(s).

Yes, I (we) agree and understand the above statement

Please specify anything we should know about (Health issues, concerns, etc.)

Emergency Contact #1 Name

Emergency Contact #1 Phone

Emergency Contact #2 Name

Emergency Contact #2 Phone

Print Full Name of Person Filling Out This Form

I declare that the info I’ve provided is accurate & complete. AND I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program. All individuals under the age of 12 MUST be accompanied by an adult on the premise.

CUSTOMER'S RIGHT TO CANCEL (a) You may cancel this contract by sending notice of your wish to cancel to the center before midnight of the third business day after you sign the contract. 'Business day' means Monday through Friday excluding state holidays and federal holidays. The center shall return any payments made and any note or other evidence of indebtedness. If you use the seller's facilities or services, the center may deduct a reasonable fee from the payments being returned based on the actual fee paid divided on a pro rata share by the number of days used by the customer. (b) In addition, you or your estate may also cancel the contract at any time by written notice to the center at the above address if the following circumstances occur: (1) the customer's death; (2) substantial physical disability, certified by a physician, which makes it permanently impossible for the customer to use the center's services; (3) the customer's permanent relocation to a residence over fifty miles distant from an outlet operated by the center, if the center is unable to arrange for the customer's use of another center with equivalent major facilities and services. The center may require presentation of information to substantiate that one of these circumstances has occurred. If the contract is cancelled because of disability, death, or permanent change of residence, the center shall return any note or other evidence of indebtedness and unearned prepayments as follows: For each month that the contract was in effect, the center is entitled to the rate a month or a treatment which it would have charged if the contract had initially been one for the number of months or the number of treatments for which the contract was actually in effect. The rate is to be determined from a fee schedule in effect on the date of the contract. (c) The right of cancellation shall affect only the financial obligations under the contract and customer's right to use the center's physical fitness services. BY CHECKING THIS BOX, I ACKNOWLEDGE THAT I HAVE BEEN PROVIDED A COPY OF THIS CONTRACT.

Today's Date

Primary Membership-holder Signature

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The Scrapyard LLC., Access & Liability Waiver *A one-time $25 fee will be required upon submission of this form.

Primary Membership-holder Information (Required)

Secondary Membership-holder Information (For Couples)

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The Scrapyard LLC.,
Access & Liability Waiver
*A one-time $25 fee will be required upon submission of this form.