Paynesville Fitness Center - Membership Enrollment (Online Form)
Welcome to Paynesville Fitness Center a Paynesville Area Community Education Program! We are so very excited to welcome you to our Fitness Family.
Please see below for our Online Membership Enrollment Online Form.
Make sure you read all information closely as you are entering into an agreement with Paynesville Area Community Education (Fitness Center).
If you have specific questions regarding the agreement please email Matt Dickhausen at
Date of Birth
Individual members must be 18 years of age or older. Students under a family membership must be at least 16 years of age to utilize the fitness center during non-staffed hours. Children 10 -15 may use the fitness center if parents have a family membership and the child is with them the entire time.
Home Street Address
Home Zip Code
Main Phone Number
Secondary Phone Number
Paynesville Fitness Center Single Membership Options
Paynesville Fitness Center Single Membership (12-Month Agreement) - $24/Month + Tax = $25.65
Paynesville Fitness Center Single Membership (No Contract Option ) - $32.95/Month + Tax = $35.22
If you chose the No Contract Option how many months would you like to pay for today?
Paynesville Fitness Center Family Membership Options Definition of a family: Members of an immediate family (Married adults and any children under 18 or children whom are full time college students age 22 and under living in the same household.) Students under a family membership must be at least 16 years of age to utilize the fitness center during non-staffed hours. Children 10 -15 may use the fitness center if parents have a family membership and the child is with them the entire time
Paynesville Fitness Center Family Membership (12-Month Agreement) - $39/Month + Tax = $41.68
Paynesville Fitness Center Family Membership (No Contract Option ) - $47.95/Month + Tax = $51.25
Credit/Debit Card Information - 16 Digit Number
Expiration Date - Month/Year
3 Digit Security Number on the back of the card
Name as it appears on the credit card
Is the billing address for the credit card the same as the home address listed above? If no please list address below in the "Other" section.
Paynesville Fitness Center Membership Contract
MEMBER AGREES: To abide by all the membership rules of the facility. Because physical exercise can be strenuous and subject to risk of serious injury, the school district urges you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You (each member, guest, or participant) agree that if you engage in any physical exercise or activity, or use any fitness center amenity on the premises or off premises at a school district sponsored event, you do so entirely at your own risk. This includes, without limitation, your use of the locker room, parking area, sidewalk area, or any equipment in the fitness facility and your participation in any activity, class, program, or instruction. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, damage or loss of by theft of any personal property. You expressly agree to release and discharge the school district, and all affiliates, employees, agents, representatives, successors, or assigns, form any and all claims or causes of action. This waiver and release of liability includes, without limitation, all injuries to you which may occur, regardless of negligence, as a result of (a.) your use of any exercise equipment, (b.) the sudden and unforeseen malfunctioning of any equipment, (c) our instruction or supervision, and (d.) your slipping and/or falling while in the fitness center, or on the school district premises, including adjacent sidewalks and parking areas.
Member agrees to a late penalty of 5% or $10.00 whichever is greater, if payment is received more than five days past the due date. Should you default, you agree to pay all costs of collection, including collection agency fees, court costs, and reasonable attorney’s fees, all of which may be paid or incurred by the holder of this note. Should any part of this agreement be found unenforceable the remaining parts shall remain enforceable. Member also agrees no other representation is made other than what is agreed in writing herein. Failure to use facility will not relieve you of payments.
You acknowledge that you have carefully read this waiver and release and fully understand that it is a release of liability. You agree to voluntarily give up any right that you may otherwise have to bring a legal action against the school district for negligence, or any other personal injury or property damage or loss action.
MEMBERSHIP CONTINUATION & CANCELLATION:
All membership agreements listed above as (12-Month Agreement) are for a minimum of 12 months with dues payable monthly and automatically from month to month after the initial 12 month period until 30 days written notice of cancellation is given to Paynesville Fitness Center. Membership may be cancelled prior to the completion of the initial 12 month period if the member moves more than 50 miles outside of Paynesville and 30 days written notice and proof of relocation are furnished to Paynesville Fitness Center. Membership may be suspended for medical reason upon written advice from a medical doctor. You, the buyer, may cancel this agreement within 3 business days by sending a written notice to the Paynesville Area Community Education postmarked by the third business day following the date of this agreement. If by reason of death or permanent disability, member is unable to complete his/her training program, his/her estate shall be relieved of making payments. Cancellation of this agreement under the preceding circumstances will require a 30-day notice and a twenty five-dollar cancellation fee. Other than provided for in this agreement, contract is non-cancelable.
Please type full name to act as your signature to the above membership agreement.
I agree to adhere to the above contract language and authorize first month Paynesville Fitness Center payments to be made to the above credit/debit card.
Yes (I agree to have my first monthly payment deducted from my credit card)
Yes (I agree to have the $16.03/card - 24-Hour Access Card fee deducted from my credit card)
Please type full name to act as your signature to the above agreement.
Monthly Contracted Payments must be paid through EFT (Electronic Fund Transfer). EFT's can be made from a checking or savings account.
I choose to use my ________ Account for my monthly payments.
NA - I am purchasing a No-Contract Membership
I agree to adhere to the above contract language and authorize monthly Paynesville Fitness Center payments to be made to the above checking/savings account.
Yes (I agree to have my monthly contracted payment charged to the above account)
Payneville Fitness 24-Hour Access Card Waiver & Release Form
You have agreed to purchase a membership at a facility that allows you access at any
time. As such, you are aware that there will be no supervision or assistance. You are
also aware that if you are injured, become unconscious, suffer a stroke or heart attack,
that there will likely be no one to respond to your emergency and this facility has no duty
to provide assistance to you. Even though this facility is equipped with surveillance
cameras, it is likely that should you require immediate assistance, none will be provided.
We HIGHLY recommend that you have a workout partner accompany you while at the
club, but it is entirely up to you.
Because physical exercise can be strenuous and subject to risk of serious injury, the club
urges you to obtain a physical examination from a doctor before using any exercise
equipment or participating in any exercise activity. You (each member, guest, or
participant)agree that if you engage in any physical exercise or activity ,or use any club
amenity on the premises or off premises including any sponsored club event, you do so
entirely at your own risk. You agree that you are voluntarily participating in the use of
this facility and assume all risks of injury, illness, or death. We are also not responsible
for any loss of your personal property.
This waiver and release of liability includes, without limitation, all injuries which may
occur, regardless of negligence, as a result of; (a) your use of all amenities and equipment
in the facility and your participation in any activity, class, program, personal training or
instruction,(b) the sudden and unforeseen malfunctioning of any equipment and (c) your
slipping and/or falling while in the club, or on the club premises, including adjacent
sidewalks and parking areas.
I understand that my membership only entitles me access to the facility and agree that I
will not allow anyone to use my access card or will l ever allow unauthorized access to anyone
at any time. I understand that if I were to allow unauthorized access to another person my access card will be
permanently deactivated and I will forfeit my 24-Hour Access membership.
You acknowledge that you have carefully read this "waiver and release" and fully
understand that it is a release of liability. You expressly agree to release and discharge
the club, and all affiliates, employees, agents, representatives, successors, or assigns,
from any and all claims or causes of action and you agree to voluntarily give up or waive
any right that you may otherwise have to bring a legal action against the club for
negligence, personal injury or property damage.
Note: Should any part of this agreement be found by a court of law to be against public
policy or in violation of any state statute or case precedence, then only that wording is
removed and the remainder of this agreement will remain in full force.
I Agree to the 24-Hour Access Waiver Rules/Regulations
I agree that I will not allow any other person access to the facility with my card, and understand if I do that my membership card will be deactivated and I will lose membership access privileges.
Please type full name to act as your signature to the above 24-Hour Access Rules/Regulations Agreement.
I am joining under a "Family Membership" and I need an additional number of access cards for my family members. (All family members age 16 and over must have their own access card in order to gain access to the facility) An online form for each additional family member requesting a card will be emailed to you when your membership is processed.
Thank you for joining Paynesville Fitness Center! Your 24-Hour Access Cards will be available to you as soon as they are processed. Email Matt Dickhausen at email@example.com with any questions. Thank You!
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This form was created inside of Paynesville Area Public Schools.