Smartwaiver Certificate of Authenticity

Verify Authenticity of Document

Document ID: EmKZBUsHy8iq3Kghjo65oC
Completed: 2022-05-17T22:03:33+00:00 UTC

ULTIMATE
TRAINING
CENTER
Waiver And Terms & Conditions

I hereby agree that by signing this document, I consent to waive certain legal rights, including the right to sue the following
party, and, if applicable, its owners, trainers, representatives, and facilities from any physical, material, tangible or intangible,
loss or damages that may happen to me during my participation in any of the fitness services (hereinafter,"Fitness Services")
undertaken while under their instruction or thereafter: Ultimate Training Center/ULTIMATE TRAINING CENTER (the
"Fitness Provider").

I will be voluntarily participating in the Fitness Services that will be conducted by the Fitness Provider. These Fitness Services
will include, but not be limited to the following:

Strength Training, Cardio, Zumba, Crossfit, Massage Chair, Running, Training Programs, Weight Lifting, Training Assistance,
General Fitness Exercising, Showers, Sauna, ETC.

I agree with and understand the following:

It is my responsibility to consult a physician before participating in this or any fitness program and I affirm that I have no
medical conditions that would restrict me from participating in any of the Fitness Services.

I agree to hold the Fitness Provider, and if applicable, its owners, trainers, and representatives, harmless from any damage,
whether tangible or intangible, that may happen to me while participating in the Fitness Services. Such injuries may include,

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 but are not limited to, muscle strains, muscle sprains, muscle spasms, heart attacks, raised blood pressure, and broken,
fractured, or dislocated bones.

I agree that the Fitness Provider offers the Fitness Services with no guarantee of results. I agree that I am solely responsible to
maintain the diet and fitness regime appropriate for my level of health and stamina, and I agree that any results that occur,
whether positive or negative, are the effects of my own personal choices.

I agree that participation in the Fitness Services is not a replacement for actual medical care, and that if I do experience
medical issues, I will contact my doctor immediately.

I agree and verify that all of the information that I have given the Fitness Provider and its representatives is accurate, up-to-
date, and without the omission of any known medical issues.

I agree and verify that If I have omitted any necessary personal information, whether knowingly or unknowingly, I will hold
the Fitness Provider harmless against all liability for any damages that may occur to myself or to others because of my actions
or inactions.

I agree to keep the Fitness Provider apprised of any changes or upcoming changes concerning my physical health and personal
information.

I understand and agree that it is my responsibility to let the Fitness Provider know if I find myself in any pain or discomfort
before, after, or during the Fitness Services.

If I do require medical treatment or attention while or after participating in the Fitness Services, I agree that the medical costs
are mine and mine alone and hold the Fitness Provider blameless from any charges, fees, or costs that my conditions may
incur.

This Fitness Services Waiver will bind and be enforceable against me and all of my personal representatives. I agree that this
Fitness Services Waiver should be enforceable to the fullest extent of the law, and if any portion is held invalid, the remainder
should continue in full legal force and effect.

I specifically acknowledge and agree that this document is not intended to be a general release, which would be limited under
some state and local laws.

This Fitness Services Waiver shall be construed and interpreted as broadly as possible in the applicable jurisdiction.

ASSUMPTION OF RISK. I understand and am aware that my participation in the Fitness Services involves risks. These risks
may lead to tangible or intangible harm, and I agree that they may result not only from my own actions but also from the
actions of others. With the knowledge and understanding of these risks, I choose, of my own will and volition, to continue
participating in the Fitness Services.

I am also aware that there are risks that I may not have considered, yet I waive my right to any claims that may occur from
these unconsidered risks and I choose, of my own will and volition, to participate in the Fitness Services.

COVENANT NOT TO SUE. I will not start any lawsuit or other court action against the Fitness Provider, nor will I join any
such proceeding, including any claim for money damages. I acknowledge and agree that I am entering a covenant not to sue
the Fitness Provider in any capacity, including to hold the Fitness Provider liable for any injury, loss, or damage sustained by
me or my property, even if it is due to the Fitness Provider's negligence or omission. I also waive the right of any of my
insurers' to make any such claim.

INDEMNIFICATION: I agree to defend and indemnify the Fitness Provider and any of its affiliates (if applicable) and hold
them harmless against any and all legal claims and demands, including reasonable attorney's fees, which may arise from or
relate to my use or misuse of the Fitness Services or my conduct or actions. I agree that the Fitness Provider shall be able to
select its own legal counsel and may participate in its own defense, if desired.

REPRESENTATION: I am over 18 (eighteen) years of age, and am medically and physically able to participate in the Fitness
Services.

GOVERNING LAW: This Fitness Services Waiver shall be governed by and construed in accordance with the internal laws of
Arkansas without giving effect to any choice or conflict of law provision or rule. Each party irrevocably submits to the
exclusive jurisdiction and venue of the federal and state courts located in the following county in any legal suit, action, or
proceeding arising out of or based upon this Fitness Services Waiver: Independence County.

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 I Agree

TERMS & CONDITIONS

Member will be solely responsible for timely Payments and will be billed according to the said option included in the
agreement. Following the commencement of this agreement, billing shall continue on as month to month basis until otherwise
noted by member in a written notice of no less than 35 days unless member has paid in full (see Membership Cancellation
section Below). Members are subject to $25 chargeback fee plus membership fee owed if payments are declined. A valid credit
or debit card is required to be on file for payment. A $25 Fee will be paid if membership becomes delinquent/unpaid and no
cancelation is given, as stated in this document. This agreement is legally binding by both parties and will be enforced
accordingly.

Standard Pricing for Memberships:

• Single Membership= $38(+ tax)/ every 30 days
• Family Membership =$60 (+ tax)/ every 30 days (+ $30 Per person after first two people)

CASH PAYMENTS
Members paying cash will be priced at a different rate for membership plans. Pricing for Cash paying members will be as
followed:

Single plan at $50/Month,

Family Plan at $75/month.

No discounted pricing will be available for cash payments.

MEMBERSHIP CANCELLATION:
The terms on the Membership are 30 days’ notice for cancellation, anything owed up until the date of cancellation, and any
payments set to draft in the next 30 days are owed per the signed agreement. There is a $49 cancellation fee owed if you are
canceling within the first 90 Days of new membership.

Month-to-Month - No Contract memberships can be canceled at any time, however a 30 day written cancellation notice as
required by your membership agreement. It is your responsibility to provide notice 30 days. Your membership will be
cancelled 30 days from the date notice is received. Note that within this 30-day period, one final payment will be processed as
scheduled. All payments are non-refundable.

INITIATION PERIOD
New Members have an Initiation period of 90 days, starting on the first paid day membership is purchased. During this
Initiation Period, if a cancellation notice is given within the Initiation period (first 90 days), then a Initiation Cancelation fee
of $49 must be paid, along with any unpaid dues, and the last membership payment, which will be within the 30 days after
notice is received. (Initiation Period = First 90 Days after a new member joins. This period starts the day of first paid
membership.) (Initiation Cancelation Fee = A $49 Fee applied for any cancellations within the Initiation Period.)

AUTOMATIC RENEWAL:
All Membership plans paid by monthly automatic electronic payment (credit card, debit card, or automatic checking account
draft), will automatically renew each 30 days at the same payment terms and billing date established at time of enrollment. All
prepaid plans are paid upfront and will automatically renew upon expiration at the same rate and terms as the initial
membership. Any changes to plan, or cancellation must be received 30 days in advance and follow the terms laid out in
membership cancelation section of this document. It is the members responsibility to monitor membership expiration and
renewal dates.

Ultimate Training Center reserves the right to terminate this document without further obligation at any time for any reason.
Member understands that allowing or bringing non members into Ultimate Training Center can and will forfeit membership.
All Members are required to wear clean gym shoes, and appropriate shirt and other workout attire (nothing immodest or

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 containing inappropriate or profane slogans or logos). Member(s) also agree to conduct themselves in a respectful mannerly
way toward· other members (example: sharing equipment, no harassment or profanity, and keeping noise to a minimum, etc.)
Member will be held responsible for lost or damages property that is due to negligence or misconduct in which the
Member(s) (or any children covered in this agreement) is directly or indirectly at fault. Member(s) acknowledges that they
should consult their Physician before engaging in any physical activity and therefore does not hold Ultimate Training Center
responsible for any accidents or injuries that may be incurred while using facilities. I hereby release and forever discharge
Ultimate Training Center, its management, partners, agents, contractors, and employees (whether acting within the scope of
their employment or not) from any claims, demands, or causes of action relating to or arising from Members presence or
participation in any Ultimate Training Center facility or program which may result in injury to me or even death. I intend this
release to bind my heirs, executors, assigns, administrators, personal representatives and myself. Video surveillance will be used
in appropriate areas solely for the protection of the member. This agreement is binding to all members including those
included in family membership. (One member of each family will be held financially responsible for the entire membership.)

All products and services of Ultimate Training Center and its subsidiaries and affiliates are subject to the terms and conditions
of the applicable agreements governing their use.

The Terms are to be read by you together with any terms, conditions or disclaimers provided in the pages of the Site. In the
event of any conflict, the terms provided in the pages of the Site will govern.

The information, material and content provided may be changed at any time without notice. Changes may be made to the
Terms at any time without notice by updating this posting.

No Endorsements

No endorsement or approval of any third parties or their advice, opinions, information, products or services is expressed or
implied by any Information

Links/Software

Links from or to web sites outside the Site are meant for convenience only. Ultimate Training Center does not review,
endorse, approve or control, and is not responsible for any sites linked from or to the Site, the content of those sites, the third
parties named therein, or their products and services. Linking to any other site is at your sole risk and Ultimate Training
Center will not be responsible or liable for any damages in connection with linking. Links to downloadable software sites are
for convenience only and Ultimate Training Center is not responsible or liable for any difficulties or consequences associated
with downloading the software. Use of any downloaded software is governed by the terms of the license agreement, if any,
which accompanies or is provided with the software.

Payment for Products & Services

All Credit Cards will be processed at the time of payment. Ultimate Training Center is not responsible for any fees, charges,
exchange rates or additional charges levied by individual financial institutions or Credit Card companies.

I Agree
I have read the above Fitness Services Waiver and Terms and Conditions fully and I understand and agree to its contents. I
understand and agree that by signing this Fitness Services Waiver I forfeit any right, claim, or ability to hold the Fitness
Provider responsible for any tangible or intangible damages, loss of property, or loss of life that may occur during or after my
use of the facilities and participation in the Fitness Services.

May 17, 2022

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 Members Name
Leanna
First Name*
Thi
Middle Name
Van
Last Name*

(870) 307-4146
Phone*

Female

*
Members Date of Birth
9 - September 13 2001

Members Signature*

Members Address

Address Line 1:* 489 woodmont circle

Street address, P.O. box, company name, c/o

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 Address Line 2: N/A
Apartment, suite, unit, building, floor, etc.

Country:* United States

City:* Batesville
State/Province:* AR
Zip/Postal:* 72501

Email Address

leannavann@gmail.com
Email

Check to receive information, news, and discounts by e-mail.

Email me a copy of this document.

Emergency Contact

Linda Le
Emergency Contact's Name*

(870) 793-4181
Emergency Contact's Phone Number*

*
Electronic Signature Consent
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You
have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent,
you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy
and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any
documents will continue until such time as you notify us in writing that you no longer wish to use an electronic
signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email
address in order to contact you regarding any changes, if necessary.

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 Auto Photo Capture

Photo captured when the participant clicked on the Continue button

immediately after selecting if an Adult or Minor(s) would be participating in
the activity

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Photo captured when the first participant accepted their signature

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 Photo captured when the participant signing the waiver checked the Electronic
Signature Consent box

2022-05-17T22:03:32+00:00

Photos were taken using:

Device:2nd iPad Application:3.0.0

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