FA Membership Contract | BeHealthConscious

BeHealthConscious Financial Assistance Membership Contract

First name

Last name

Date of Birth

Do you have a doctor’s permit to participate in intense physical activities?

Yes

Please specify the agreed monthly financial assistance portion that you will be responsible for each month.

Initials

I declare that the info I’ve provided is accurate & complete. I understand that I amd submitting a gym membership contract that can be canceled anytime at least within 3 days of my autodraft date. I also understand there are no refunds if I fail to submit a cancelation form within those 3 days of my auto draft date.

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.

Phone

Address

Thank You For Submitting Your FA Membership Contract

BeHealthConscious Financial Assistance Membership Contract

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