ONE.
I, [name], wish to participate in the exercise and training program offered by Gym Number Five. I understand there are inherent risks in participating in a program of strenuous exercise. Consequently, I have been examined by a physician of my choice and have obtained his/her approval for my participation in a fitness program within sixty (60) days of the date set forth below. No change has occurred in my physical condition since the date such approval was given which might affect my ability to participate in the fitness program. If a physician has not examined me, I agree to see a physician within sixty (60) days of the date set forth below to obtain his/her approval for my participation in a fitness program. I agree that Gym Number Five, LLC shall not be liable or responsible for any injuries to me resulting from my participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge Gym Number Five, LLC, its owners, employees, agents and/or assigns, from all claims, actions, judgments and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with my participation in the fitness program. This Release shall be binding upon my heirs, executors, administrators and assigns

TWO.
I certify that the answers to the questions outlined on this form are true and complete to the best of my knowledge. I acknowledge that medical clearance is required if I have answered “Yes” to any of the questions on the form. I understand and agree that it is my responsibility to inform my Personal Trainer of any conditions or changes in my health, now and on going, which might affect my ability to exercise safely and with minimal risk of injury.

THREE.
I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my Personal Trainer.

FOUR.
I understand the results of any fitness program cannot be guaranteed and my progress depends on my effort and cooperation in and outside of the sessions.

FIVE.
I understand that Gym Number Five bills its Personal Training clients on a pre-pay basis. Once my trainer and I have decided upon the type of training package and payment plan I will purchase, payment must be made before the sessions are conducted. Credit cards, cash, and checks made payable to Gym Number Five are all accepted. I understand that all Personal Training sessions are non-refundable - No personal training refunds will be issued for any reason, including but not limited to relocation, illness, and unused sessions.

SIX.
A. I understand that Gym Number Five operates on a scheduled appointment basis for all Private Training sessions and thus, requires that I provide 24 hours notice when canceling an appointment. No charge will be levied should I cancel with MORE than 24 hours notice given. Should I cancel a session without 24 hours prior notice, I will be charged in full for that session. I understand that Gym Number Five recommends that all canceled sessions be rescheduled to ensure consistency and fitness progress.

B. DISCOUNTED TRAINING PACKAGES:
i. AUTO-BILLED WEEKLY TRAINING PACKAGES - All sessions are active for ONE month after the purchase date.
ii. PRE-PAID PRIVATE SESSION PACKAGES - Expiration Policy: All personal training sessions expire 120 days from the purchase date. Personal training sessions are void after this time period.

C. Exceptions to the above deadlines are to be made at the sole discretion of Gym Number Five management and coaches.

SEVEN.
I understand that the usage of any nutritional supplements is done under my own will and has not been prescribed by my Personal Trainer.

EIGHT.
I understand that Gym Number Five photographs many of their client events/sessions and I provide written approval for them to use these pictures or videos for promotional purposes.

I have read this Release and Terms of Agreement and I understand all of its terms. I sign it voluntarily and with full knowledge of its significance.