In exchange for the permission granted to me by the to participate in the physical activity of the Fluid Health & Fitness LLC exercise program and services (“Program”), I agree to the following:
1. I understand that my participation in the Program carries with it a risk of serious bodily injury, death or personal property damage or loss. This risk may arise, not only from my own acts, omissions or negligence but from acts, omissions or negligence of others, from the condition of the premises of the Program, or from the condition, adequacy or appropriateness of any equipment used in the Program. I understand that I will be exposed to a range of dangers and risks, including, but not limited to hazards associated with exercise and fitness activities. Further, I understand that there may be other risks associated with the Program that I am not now aware of and that cannot be reasonably foreseen.
2. I agree to disclose to my Fluid Health & Fitness LLC instructor or representative any physical conditions, limitations, disabilities, ailments, or impairments which may affect my ability to participate in the Fluid Health & Fitness exercise program and services and I agree to update this disclosure if and when necessary so that my instructor is able to assist me in limiting or redirecting my activities as I progress.
3. I expressly and voluntarily assume all risk of injury, death and property damage or loss that may result from my participation in the Program.
4. On behalf of myself, my personal representatives, heirs, next of kin and anyone who obtains any rights from me, I hereby waive, release, and discharge Fluid Health & Fitness LLC, its members, officers, directors, owners, agents, representatives, contractors and employees and all other persons and firms involved in any way with the Program (the “Released Parties”) from liability for bodily injury, death, property damage or loss related in any way to my participation in the Program, including any losses caused by the negligence or strict liability of the Released Parties. I am not releasing the Released Parties from liability for any willful or intentional acts.
5. I understand that I am giving up all my claims, which may exist now or may arise in the future against the Released Parties. I also understand that I am accepting all responsibility for all costs and damages that I might incur or that might be incurred on my behalf in the event of any injury or accident.
6. If any portion of this agreement is held invalid, it is agreed that the balance thereof shall continue in full force and effect. This Release and Consent shall be governed by Minnesota law.
•I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND ITS CONTENTS. I UNDERSTAND IT IS A RELEASE OF ALL CLAIMS
•I UNDERSTAND THAT I AM ASSUMING ALL RISKS INHERENT IN THE PARTICIPATION IN THE PROGRAM.
•I VOLUNTARILY DIGITALLY ACCEPT, AND THEREBY STATE MY ACCEPTANCE OF THE ABOVE PROVISIONS.
IF THE PARTICIPANT IS A MINOR, HIS OR HER PARENT OR GUARDIAN MUST SIGN.
I am the parent or guardian of the participant. I am signing this Release and Waiver on my own behalf and on behalf of the participant and his or her heirs and assigns. I hereby affirmatively state that the said Participant is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost or expense that they may incur as result of the death or any injury or property damage that said participant may sustain while participating in activities at any such Fluid Health & Fitness, LLC facility.
I HAVE READ THIS DOCUMENT. I FULLY UNDERSTAND ITS CONTENTS, AND HEREBY ACCEPT ITS PROVISIONS.
Authorization for Scheduled Payments. I am an account holder and/or I have actual authority to use the credit card or bank account with which my payments will be made under the Scheduled Payment Plan agreed upon, including Recurring Payments. I authorize Fluid Health & Fitness Corp, to process my payments monthly, starting from the date of the first withdraw and continuing on the same calendar day monthly, without further notice to me. To withdraw this authorization, I agree that I will comply with the Contract Cancellation provision below.
Contract Cancellation and Refund Policy. Cancellation Within 3 days or Before First Service. I may obtain a refund of any amount I have paid under this Agreement if I cancel it within three business days of the date I signed it or at any time before my first session is serviced, whichever is later. Cancellation after first service. Once my first session (after the 3-day window to cancel) has been serviced, I may cancel this Agreement at any time, but all payments I have made to or that have been processed by Fluid Health & Fitness Corp, prior to its receipt of my written cancellation notice are nonrefundable. Fluid Health & Fitness Corp, will service the sessions for which I have paid on the schedule in effect at the time of cancellation. To cancel this Agreement, I will deliver a written notice of cancellation.
Session Redemption and Cancellation I agree to complete all the sessions I have purchased with this Agreement on or before the Expiration Date Above. If I cannot attend a scheduled session, I will contact Fluid Health & Fitness Corp, via email at least 24 hours in advance of the session. Subject to the Contract Cancellation provision above, I will forfeit, and I agree to pay for, any sessions I fail to attend without such 24-hour advance notice and any sessions I do not complete by the Expiration Date. Fluid Health & Fitness Corp, reserves the right to reschedule or assign an alternative wellness coach to service my session(s) at any time and without notice.
Assumption of Risk and Waiver of Liability. I agree and understand that the Program(s) which I have purchased with this Agreement involve the risk of injury, and elect to participate in the Program(s) voluntarily in spite of the risk. I assume the risk of all injuries, and waive all negligence claims, related in any way to the Program(s) , including but not limited to conduct on the part of Fluid Health & Fitness Corp, any of it's employees or consultants, or equipment failure, malfunction, or defects.
Satisfaction Guarantee: If you are not completely satisfied with your Fluid membership, Fluid will allow you to cancel your membership within the first 30 days, subject to the following terms and conditions:
1. You must have met with a Movement Specialist/Marketing Representative to complete your personal Fitness Profile within the first 30 days of your Membership Start Date; and
2. You must have attended a follow-up appointment with a Fluid Manager within the first thirty (30) days of your Membership Start Date; and
3. Cancellation must be submitted in writing at your enrolling facility within thirty (30) days from your Membership Start Date.
Subject to the foregoing criteria, Fluid will refund to you any enrollment fees and membership dues paid by you during the first 30 days. Refund applies only to enrollment fees and monthly membership dues. You will not be refunded any monies paid for a la carte services (including Personal Training, nutrition services and massages), whether paid monthly, Prepaid, or Paid in Full, and any unused services term or sessions will be forfeited without refund upon cancellation of your membership.
Month-to-Month plans and memberships can be canceled at any time, however we must receive written email notification thirty (30) days prior to your credit/debit card processing date to cancel your monthly membership at (firstname.lastname@example.org). All plans and monthly memberships require a minimum of 30 days written notice prior to next billing date to assure cancellation of automatic payments. Cancellation requests submitted within the 30 day billing cycle will result in a final payment drawn from your account on your established auto draft date. Once final payment has been drawn from your account, clients will have 30 days from the last bill date to use the facilities. It is your responsibility to provide written notice 30 days in advance of your next billing date. There will be no refund issued once a payment has been charged to your credit card. All monthly recurring term plans of 6 months and 12 months require 30 days written notification prior to your next bill date and will incur an early cancellation fee equal to one month membership for that plan.
I have read this Agreement thoroughly, understand all of its terms, and have knowingly and voluntarily agreed to it.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ USES AND DISCLOSURES TREATMENT: You have been referred to Fluid Health and Fitness by OSI Physical Therapy (“OSI”) Fluid Health & Fitness is a HIPAA Business Associate to OSI. Certain health information may be shared between Fluid Health & Fitness and OSI healthcare professionals for the purposes of evaluating your health and diagnosis of medical conditions, and to satisfy any legal or regulatory reporting requirements.
By agreeing to this Notice of Privacy Practice you agree to allow Fluid Health & Fitness to display certain fitness metrics on screens and tablets during exercise and workout sessions in which you participate. This includes, but not limited to, heart rate zones, heart rate variability, exercise protocol zones. None of this is considered to be Protected Health Information (PHI) under HIPAA. These displays will be explained to you as part of your orientation as a Fluid Health & Fitness Member. Please ask if there is anything you do not understand.
PAYMENT: Fluid Health & Fitness charges you directly for training services provided. Fluid Health & Fitness does not make and charges or gain any reimbursement from healthcare insurance or other financial institutions for the training services provided to you.
INDIVIDUAL RIGHTS: You have certain rights under the federal privacy standards that include:
•The right to request restrictions on the use and disclosure of your protected health information.
•The right to inspect and request a copy of your protected health information.
•The right to receive an accounting of how and to whom your protected health information has been disclosed
•The right to receive a printed copy of this notice
FLUID HEALTH & FITNESS DUTIES: We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. Right to Revise Privacy Practices: As permitted by law, we reserve the right to amend or modify our privacy policies and practices so that they conform to federal and state laws and regulations. Whatever the reasons for these revisions, we will provide you with a revised notice on your next visit to the Fluid Health & Fitness facility. The revised policies and practices will be applied to all protected health information that we maintain. Should you want to inspect or copy your protected health information please submit a request in writing.
IF YOU WOULD LIKE TO INQUIRE FURTHER ABOUT OUR PRIVACY PRACTICES OR SUBMIT A COMMENT YOU MAY DO SO AT THE FOLLOWING ADDRESS. HIPAA PRIVACY OFFICER, FLUID HEALTH & FITNESS, 5639 MEMORIAL AVE N, STILLWATER, MN 55082
If you believe your privacy rights have been violated, please contact us at the above address.