York JCC Small Group Training - See Results and Gain Support

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HEART Monthly Draft Agreement

Monthly Draft Agreement

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MONTHLY AUTOMATIC DRAFT AGREEMENT

This agreement is for the Monthly Draft Commitment. Direct payment of the total monthly fees will be made by your financial institution as selected below.
Termination Policy: This agreement may be cancelled by you with written notice given to the York Jewish Community Center (the York JCC). The agreement will go into effect the next billing month and will not retro credit.

PAYMENT METHOD AUTHORIZATION

I hearby authorize the York JCC to debit my account $75 on monthly basis

PAYMENT METHOD AUTHORIZATION

I hearby authorize the York JCC to debit my account $105 on monthly basis

Payment Method(Required)

Credit/Debit Card Charge

Use account on file

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INFORMED CONSENT FOR FITNESS TRAINING AND RELEASE OF LIABILITY

I, for and in consideration of monies paid/or to be paid to the York JCC for use of their physical fitness training equipment and staff, do hereby acknowledge and understand that in using the equipment, facility, and services of the York JCC that I do so at my own risk. I have been informed by the York JCC that in participating in physical fitness training at the York JCC that I assume all risk of injury, illness or death which may result there from and hereby release and discharge the York JCC and its agents, servants, employees from any actions, claims, demands for damages, suits, or causes of action, especially all claims in liability arising out of or in any way connected with my participation in physical fitness training and/or use of the equipment and facilities of the York JCC pertaining to said activity.
I understand and further acknowledge that there is an inherent risk of being injured during participation in physical fitness training. Said injuries including but not limited to fractures, ligament/cartilage damage, sprains/strains and/or contusions and abrasions which could result in temporary or permanent injuries and impairment to or the use of my extremities. I am voluntarily participating in these activities and the use of any physical fitness training equipment of the York JCC.
I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment or machinery except as hereinafter stated. I do hereby acknowledge that I have been informed of the need for a physician's approval for my participation in an exercise/fitness activity or in the use of exercise equipment and machinery. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician as to physical activity, exercise and use of exercise and training equipment so that I might have his/her recommendations concerning these fitness activities and equipment use. I acknowledge that I have either had a physical examination and been given my physician's permission to participate, or that I have decided to participate in the activity and use of equipment and machinery without the approval of my physician and do hereby assume all of the risk associated with my participation in physical fitness training and the use of equipment and machinery associated with same.
I hereby certify that I have read the contents of the Informed Consent and Release of Liability, have receive a signed original of the Agreement and thereby agree to be bound by the terms of same and any other rules and regulations adopted by the York JCC in connection with the use of its facilities and equipment, all of which have been fully explained to me. I agree that the foregoing obligations shall be binding upon me personally, as well as my heirs, executors, administrators and assigns and I understand the nature and effect of executing this Agreement.

By checking this box and printing my name below, I verify that I have read agree to abide to this agreement.(Required)

I have read, understand, and agree to abide to this agreement

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