Untitled Form

Club Membership Application

California Health and Fitness Center

Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Date of Birth / MM / DD YYYY
Gender Male Female
Home Phone - (###) - ### ####
Work Phone - (###) - ### ####
E-mail Address
Drivers License #
Employer
Corp. Number
Membership Type Single Couple Family Family Add On Corporate Upgrade
Related Membership #
Original Membership #
Comments
Signature (Initials)
Cosigner FirstParent or guardian: On behalf of my minor child and myself, I agree to the Release of Liability / Assumption of Risk and Arbitration clauses on this Agreement and I agree to defend and indemnify Etalon Fitness to the fullest extent permit option Second Financial Cosigner. I Agree to the arbitration clause in this Agreement, and I promise to pay any financial obligation that the member does not pay for any reason. I also agree to defend and imdemnify Etalon Fitness to toption
Whether Parent or Consigner, I understand my obligation can only end if the membership according to this Agreement. Signature (Please Type Your Full Name) First Last
Date / MM / DD YYYY
Home Phone - (###) - ### ####
Work Phone - (###) - ### ####
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Last 4 Digits of SSN
I Agree That I have read the Information above. The printed name is my own as well as the last 4 digits of the SSN. I Agree
RELEASE OF LIABILITY • ASSUMPTION OF RISK • BUYER’S RIGHT TO CANCEL The use of the Facilities at CHFC naturally involves the risk of injury to you or your guest, whether you or someone else cause it. As such, you understand and voluntarily accept this risk and agree that CHFC will not be liable for any injury including without limita- tion personal bodily or mental injury economic loss or any damage to you, your spouse, guests, unborn child, or relatives resulting from the negligence of CHFC or anyone on CHFC’s behalf or anyone using the Facilities, Further, you understand and acknowledge that CHFC does not manufacture any of the ﬁ tness or other equipment at its Facilities, but purchases and/or leases equipment from third parties. As such, you understand and acknowledge that CHFC is providing recreational services and can not be held liable for defective products. You understand and voluntarily accept risk and personal responsibility for any purchases that you make at CHFC. If there is any claim by anyone based on any injury, loss, or damage described here, which involves you or your guest, you agree to (1) defend CHFC against such claims and pay CHFC for all expenses relating to the claim and (2) indemnify CHFC for all liabilities to you, your spouse, guests, relatives, or anyone else, resulting from such claims. This Agreement is not effective until you and an authorized CHFC representative sign and date it. By signing it below, you agree to all the terms on the front and back pages of this Agreement and acknowledge you received a copy of it and the Membership Policies. Also, you understand that: You, the buyer, may cancel this Agreement at any time prior to midnight of the third business day of the CHFC after the date of this Agreement, excluding Sundays and holidays. To cancel this Agreement, mail or deliver a signed and dated notice, or send a telegram which states that you, the buyer, are canceling this Agreement, or words of similar effect. Such notice shall be sent to 3040 Clairemont Drive, Ste. A San Diego, CA 92117. Provisions must be read and can be found at: http://www.usgsf.com/prov.pdf Last 4 Digits of Your SSN For Signature
Name First Last
Date / MM / DD YYYY
I Agree That I have read the Information above. The printed name is my own as well as the last 4 digits of the SSN. I have read the Information and authorize this agreement . I have gone to http://www.usgsf.com/prov.pdf and read the provisions and authorize this agreement .