NEW CLIENT FORM

Athlete/Client Name *

First Name

Last Name

Parent Name

(If completing this form for an athlete under 18 years of age)

First Name

Last Name

Date of Birth

MM

DD

YYYY

Phone

(###)

###

####

Emergency Contact 1 *

First Name

Last Name

Emergency Contact 1 Phone *

(###)

###

####

Emergency Contact 2

First Name

Last Name

Emergency Contact 2 Phone

(###)

###

####

Pure Performance Rules & Regulations *

1. In order to participate, we must have a credit card on file prior to your session, or you must pay prior to your training session. 2. If an appointment is cancelled by the client within 24 hours of session time, the client will be responsible for paying the full price of the training session. 3. Closed toed shoes must be worn at all times by program participants. 4. Chewing gum is not permitted during training sessions. 5. The following behavioral violations may result in discontinued service without refund: a. Repeated use of profanity b. Disrespectful speech towards a staff member or other customer c. Refusing to participate in a training session d. Intentional damage of training equipment or facility (throwing or spitting) 6. Pure Performance is not responsible for lost or damaged personal items. 7. Customers will be responsible for replacing equipment damaged as a result of improper use or a failure to follow instructions.

I confirm that I have read and understand the rules and regulations listed above and will comply to them during my time at Pure Performance.

Terms of Use Agreement

1. Sessions purchased in a package expire after 60 days. Pure Performance reserves the right to extend packages on a case-by-case basis. 2. Individual sessions purchased in advance after 1 calendar year. 3. Pure Performance reserves the right to refuse service to customers with outstanding balances until payment for services is received. 4. Pure Performance reserves the right to discontinue service without refund for any violation of previously stated rules and regulations. 5. Pure Performance requires a credit card to be kept on file for each customer for billing purposes. 6. No services will be provided until billing information has been received 7. Sessions performed beyond current package limits will result in a single session charge until a new package is purchased. Overdue charges must be reconciled prior to new package purchase. 8. After 30 days, outstanding balances will be charged to the credit card on file. A past due fee (10% of total outstanding balance) will be added to the current balance. 9. If a client cancels an appointment within 24 hours of appointment time or doesn't show, the client will be responsible for paying the full cost of that session.

I have read and understand the Terms of Use stated above.

Informed Consent

I acknowledge the potential heath risks that may ensue while participating in vigorous exercise. I acknowledge that I have been evaluation by a physician and cleared to participate in a vigorous exercise program. I have made known all preexisting conditions and current medications that I am currently taking to Pure Performance LLC. I affirm that I will not hold Pure Performance LLC liable for any damages or medical expenses in the event of a medical emergency or injury that occurs while I am under the care of Pure Performance.

I have read and fully understand this document and verify that I agree with and will comply to the statement above.