Body Changes Gym
304 4th Ave. E; P.O. Box 622, Superior, MT.59872
Phone: 406-822-5422
Fax: 406-822-0786
Card No Assigned:Start Date:Employee Name:
Membership Application
Name: ______DOB: ______
Mailing Address: ______City:______Zip: ______
Phone: ______Cell:______email:______
Emergency Contact: ______Relation: ______Phone: ______
If Under the age of 18, you must have parents’ permission and adult supervision to be in the GYM
Legal Guardian Name: ______Signature: ______
The legal guardian must fill out this form. Both minor and guardian must sign form in the presence of a Body Changes GYM staff member. The legal guardian is FULLY RESPONSIBLE for any and all damage, mishaps, non-policy action, etc.
Please Read and Initial:
Body Changes Gym
304 4th Ave. E; P.O. Box 622, Superior, MT.59872
Phone: 406-822-5422
Fax: 406-822-0786
Card No Assigned:Start Date:Employee Name:
_____ 1. I understand that I am to have my own cell phone with me in the event of an emergency.
______2. We expect all members to treat our facility, equipment and other members with respect and courtesy.
_____ 3. You are required to change into gym shoes upon entering the building. Bring your own towels and shower items
_____ 4, You will wipe down equipment after each use.
_____5. I am aware of usage instructions and warnings
posted on all equipment.
_____6. Any infractions will cause your membership to be terminated.
_____7. All minors will need to have a legal guardian sign their application and be responsible for them.
_____8. A complete application and liability form must be signed and on file.
Body Changes Gym
304 4th Ave. E; P.O. Box 622, Superior, MT.59872
Phone: 406-822-5422
Fax: 406-822-0786
Card No Assigned:Start Date:Employee Name:
Gym Information and Policies
Body Changes Gym
304 4th Ave. E; P.O. Box 622, Superior, MT.59872
Phone: 406-822-5422
Fax: 406-822-0786
Card No Assigned:Start Date:Employee Name:
One Time Activation & Keycard Access $30.00
(Lost card $20)
Monthly Membership: $35PER PERSON______
Pro-Rated Month: ______
One session no card:$5 ______
Six Month: $175(one month free) ______
Twelve Month:$350(two months free) ______
Gift Certificate:______
Tanning Bed: (1 session) $3______
(10 sessions) $27.50______
(20 sessions)$44______
Merchandise:______
Total______
Body Changes Gym
304 4th Ave. E; P.O. Box 622, Superior, MT.59872
Phone: 406-822-5422
Fax: 406-822-0786
Card No Assigned:Start Date:Employee Name:
** When you pay your deposit of $30.00 please note that only $10.00 will be refunded to you for activation and processing. Refunds are processed one time per month. If you have missed the day of the month that you quit the gym your refund will be processed the following month. If you choose to have your card suspended for any length of time it is your responsibility to notify us and we will place your card in suspension status until you notify us.
24 hour Video Surveillance
For your protection and ours. All memberships are due by the 1st business day of each month and are non- refundable. If no payment is made your card will be deactivated on the 10th of the month.
Liability Release
I do hereby waive, release and forever discharge Body Changes GYM and its owners/employees or agents from any and all responsibilities or liability or damages from my participation in any activities or use of equipment / machinery in the above-mentioned facility. I do also hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury/damage to myself, including those caused by the negligent act or connected with my participation in Body Changes GYM or the use of any equipment at Body Changes GYM.
I understand and aware that strength, feasibility and aerobic exercise, including the use of equipment are potentially hazardous activities. I also understand that fitness activities involve risk of injury and even death. I am voluntarily participating in these activities and using equipment /machinery with knowledge of the danger involved. I hereby agree to expressly assume and accept any and all risks of injury and death.
I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation Body Changes GYM. If using this facility for recovery of injury or physical therapy programs, physician’s approval is suggested. If any further injury is acquired we as Body Changes GYM cannot be held responsible.
The tanning bed is a separate charge and has its own sign in sheet which must be signed upon entering the tanning room. If using the tanning bed with no package purchased, a fee of $3 per tan will be billed to your account. Maximum exposure time is 15 minutes a day, longer could result in injury. Consult a physician regarding any medications; certain ones may increase your sensitivity to ultraviolet light, and research is showing a link to skin cancer after using tanning beds. DO NOT USE IF PREGNANT! I hereby agree to expressly assume and accept any and all risks of injury and death by using the tanning bed. This information is posted on a large sign in the tanning room, it is my obligation to comply with the instructions.
I understand and verify that I have a cell phone that will work in case of an emergency.
When a membership is purchased it is for the whole month whether you have used the GYM or not. If you choose to cancel your membership you need to tell us at the start of the month or a new charge will be given. Turn in your key at that time, if you decide to reapply for the GYM the activation cost will be $30.00
Signature: ______Date: ______
Legal Guardian: ______Date: ______