Online Gym Membership Form
Please fill out this form to begin your membership.
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Email *
Beginning January 1, 2023 - PRIMAL Strength and Fitness will NOT allow gym members under the age of 15 to use the gym without adult supervision. Children under 15 MUST BE SUPERVISED and WITH a parent during each workout. Children cannot just come and "hang out" while I use the gym.
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Last Name *
First Name *
I was referred by: (Current Gym Member Name) - optional
Birthdate *
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Age (on the day of this form) *
Email Address I Use Most Often *
Full Address *
Cell Phone *
Emergency Contact and Phone *
Payment Information: all payments are collected via Quickbooks Online on the 15th of the month. You can pay monthly or yearly. Please select the option that fits your payment preference.  *
Quickbooks will send you information to set up your membership. Please do this right away. Your membership is not active until you fill out the payment information.  *
Your Membership Type *
I authorize PRIMAL Strength and Fitness LLC to electronically debit my bank account according to the terms of one year.
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This payment authorization is to remain in effect until I, the gym member, notify PRIMAL Strength and Fitness LLC of cancellation upon one year agreement is satisfied. I MUST notify PRIMAL Strength and Fitness LLC to cancel my subscription after my agreement is satisfied. Billing will continue after the one year agreement if I fail to notify PRIMAL Strength and Fitness LLC of my intention to cancel. *
READ THIS CAREFULLY - I have read the payment agreement for  PRIMAL Strength and Fitness . Payment Agreement: I understand I'm enrolling in a monthly or yearly subscription program, and I authorize PRIMAL Strength and Fitness  to debit my bank account the monthly amount each month for my agreement subscription. I understand that my billing information will be used for a period of 12 Months  from the date of this agreement or on about the 15th of the month.  I understand that only James Brooks of PRIMAL Strength and Fitness  has discretion and can cancel my subscription plan and that a $150 cancellation fee, or half the remaining balance of my membership dues WILL BE APPLIED to cancel before my agreement is satisfied.   *
Participation Waiver and Release WAIVER OF LIABILITY FOR PRIMAL Strength and Fitness LLCI hereby understand and acknowledge that the training, programs and events held by PRIMAL Strength and Fitness LLC may expose me (or my child) to many inherent risks, including accidents, injury, illness, or even death. I assume all risk of injuries associated with participation including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and all other such risks being known and appreciated by me. I hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with participation in activity. I acknowledge that I am (or my child) is  physically fit and mentally capable of performing the physical activity I choose to participate in.  After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and PRIMAL Strength and Fitness LLC furnishing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD HARMLESS, WAIVE AND RELEASE PRIMAL Strength and Fitness LLC its officers, property owners, agents, employees, organizers, representatives, and successors from any responsibility, liabilities, demands, or claims of any kind arising out of my participation in PRIMAL Strength and Fitness LLC  training, programs and/or events. By my signature I indicate that I have read and understand this Waiver of Liability. I am aware that this is a waiver and a release of liability and I voluntarily agree to its terms. *
Required
24-Hour Access Release of Liability and Assumption of Risk:24-HOUR ACCESS RELEASE OF LIABILITY & ASSUMPTION OF RISK As a 24-hour secure-access fitness facility,PRIMAL Strength and Fitness LLC (hereafter referred to as "the gym"), has a few different policies and procedures than a typical fitness facility. Please read the information carefully. If you have any questions, please ask. Compliance with Rules: I understand and agree that a 24-hour gym membership is a special membership based on trust and is a privilege, which can be taken away for a violation of rules. As a gym member, I agree to abide by all gym membership rules in this contract. .The additional rules below apply to a 24-hour membership:Mandatory 24-hour KEY-FOB of $50. - Unless waived by James Brooks Gym Members MAY NOT open the front door for anyone. Only James Brooks, cleaning staff, maintenance staff or coaches may unlock the front door. KEY-FOB sharing is strictly prohibited and will result in immediate loss of membership. KEY-FOB sharing is viewed by ownership as stealing services. Only active account members will be allowed entry. ***CHILDREN ARE NOT ALLOWED TO BE AT THE GYM WITH YOU*** This means - Your children CANNOT come to the gym with you and "hang out" while you workout.  PRIMAL Strength and Fitness LLC DOES NOT carry liability insurance for any child under 15 years of age who is not enrolled in a “gym sponsored activity or class.” I agree that improper unauthorized use of the facility may result in gym member suspension or cancellation. I agree not to let anyone use my KEY-FOB for any reason, and I agree to report any situation that appears to be KEY-FOB sharing to the gym. One act of KEY-FOB sharing will result in immediate membership suspension or termination. The gym reserves the right to suspend or cancel the rights, privileges and membership of any member whose actions are detrimental to the use of the gym. Equipment Use: I agree to treat all equipment safely and place used pieces of equipment back in the proper storage racks or holders. I am aware that if I get injured, become unconscious, suffer a stroke or heart attack or any other medical emergency or event that there will likely be no one to respond to my emergency and that the gym has no duty to provide assistance to me while I am at the gym. *
I understand and agree that a 24-hour gym membership is a special membership based on trust and is a privilege, which can be taken away for a violation of rules. Examples include: Letting in friends, failure to put equipment away after use, misuse of barbells and/or equipment. This will be enforced as "being reported to me or by video camera." In order to keep a keyfob, you must be responsible enough to be trusted. *
Please Watch This Video to Learn How to Clean and Organize After Your Workouts.
I watched the cleaning and sanitizing video. *
KeyFob Payment: $25 one time fee for everyone-  for the Life of Your Membership.  This payment must be made before getting your 24 hour keyfob. *
Keyfob Set Up Time *
Signature (type your full name) *
A copy of your responses will be emailed to the address you provided.
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