Please Print
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Name of Student (Last) (First) (M)
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Birthdate (m/d/y)
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Address
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Uniform Size
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City
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Postal Code
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Home Phone #
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Emergency Contact
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Phone #
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Address
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Relation
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Emergency Contact
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Phone #
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Address
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Relation
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List any medical/health problems.
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Co-Signer if under the age of consent - Relation to Client
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Name of Parent/ Guardian(Last) (First) (M)
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Address
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City
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Postal Code
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Phone #
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Business #
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Cosigner agrees to pay the dues or other payments required to pay under this agreement.
The person whose name appears above applies for Training at The Meditative Warrior with Ed Gatti (and/or staff) on terms set out in this contract agreement.
This document is an application for Junior Ninjitsu Martial art related training services and will form an agreement between the Client and The Meditative Warrior. I, The Meditative Warrior, will make no representation or warranties, written or oral, expressed or implied, other than those in this agreement.
A service charge of $25.00 will be added on each cheque or other payments which is not honored or made by the Client’s bank and savings institution. Administration fees are non-refundable.
Promise to Pay
The Client hereby promises to pay The Meditative Warrior dues in the amount of $50.00 per month, hereinafter referred to as “Dues”, and said Dues are to be paid by the 2nd class of each month, in order for the student to take classes.
I, The Meditative Warrior, may cancel the Client’s right for Junior Ninjitsu and Martial art related training if the Client fails to pay his/her Dues within 7 days from the date they are payable. I, The Meditative Warrior, with my discretion, may re-admit the defaulting client for my Junior Ninjitsu and Martial art related training services.
In certain circumstances (at the sole discretion of The Meditative Warrior) the client is not able to commit to the full agreement; the member is responsible for all training sessions to be paid up to date. Under this circumstance, a partial month will be counted as a full month.
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Assignment
The Client acknowledges and agrees that this Agreement and Promise to Pay may be assigned by The Meditative Warrior at its sole option to a third party, provided that the Client shall receive notice in writing of any such assignment. The Client acknowledges receipt of a copy of the agreement, acknowledges having read and understood its terms and agrees to be bound by its terms contained in this document.
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The Meditative Warrior Membership confirmation;
Mr.,Mrs.,or Ms. (print)____________________________________________( Student)
Signed ________________________ Date of Acceptance ______________
Co-Signer if under the age of consent - Relation to Client
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Name of Parent/ Guardian(Last) (First) (M)
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Address
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City
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Postal Code
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Phone #
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Business #
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Please Read Carefully
1) Health Information
The Client represents that she/he is not aware of any existing mental or physical condition which might reasonably be expected to put him/her at any risk in using the facility than that of a healthy woman/man of his/her age.
2) Default
The Meditative Warrior has the right to revoke the Client’s training contract in writing to the client if;
a) any information given by the member on the previous pages is false at its time given;
b) the client breaches any of the rules of this agreement or the rules of the facility;
c) the client makes an assignment in favor of creditors or is declared or is bankrupt, or
d) the client fails to make any payment under the agreement within 3 days of the time it becomes due.
3) Refunds, Transfers, and Cancellation by Client
This agreement is non-refundable and non-transferable by the Client and may not be cancelled by the Client, except a) pursuant to the right of cancellation set out on the front of this agreement, and
b) limited by circumstances provided in the Consumers Protection Act of Virginia such as relocation, death and permanent disability.
4) Location
Should the current training facility at Midlothian Middle school be unavailable for the Client’s use due to damage caused by fire, act of God, catastrophe, accident, lease expiry, or for any reason whatsoever, the Client shall use the geographically nearest alternate facility.
5) Compliance with Rules and Regulations
The Client agrees to comply with the rules and regulations of The Meditative Warrior, relating to the use of the facility; including safety, acceptable clothing and footwear, hygiene and conduct.
6) Duty of Care
The Client agrees to exercise ordinary care while using the facilities for the protection of the Client and others.
7) Lost or Stolen Property
The Meditative Warrior or the facility is not liable for any stolen or lost property of the Client or guest.
8) Time
The Client will understand postponement in the event of absence of The Meditative Warrior, which may be due to illness, injury or being out of town, in which case the student will be notified by phone the previous day.
9) Indulgences
No failure or delay by The Meditative Warrior in enforcing any right under this agreement will operate as a waiver of that right under this agreement or prevent The Meditative Warrior from exercising any other right under this Agreement. No amendment or waiver of any term of this agreement will be effective unless it is in writing, except as otherwise provided here.
10) Severability
If any provision of this agreement is found to be invalid or unenforceable, it will be considered separate and severable from this agreement and will not affect the validity or enforceability of any other term of this agreement.
11) Law
This agreement will be governed by the law of Virginia.
Release and Indemnity Agreement.
I acknowledge that the exercise, martial arts and fitness programs and the use of the exercise equipment offered by The Meditative Warrior and Chesterfield County can provide for strenuous physical exercise, and I am aware of the inherent risk of serious physical injury and other dangers associated with the use of the equipment and the programs. In consideration for The Meditative Warrior providing me with Junior Ninjitsu / martial art training services, I hereby accept and fully assume all such risks and dangers and the possibility of personal injury, death, and property damage or loss resulting from such use and participation. I also herby release, save harmless and indemnify The Meditative Warrior, Chesterfield County and all employees at the dojo and/or facility, from any and all claims, actions, costs, expenses and demands in respect to death, injury, loss or damage that I or my next of kin may suffer arising out of or in connection with my use of the equipment, my participation in the Junior Ninjitsu, martial art, fitness programs, due to any cause whatsoever, including without limitation, the negligence of The Meditative Warrior, the facility and any one or more of the employees of the dojo. I agree that the Release and Indemnity Agreement prior to signing and I am fully aware that by signing this agreement I am affecting my legal rights.
_____________________________ __________________________
Clients Signature Date
Co-Signer if under the age of consent - Relation to Client
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Name of Parent/ Guardian(Last) (First) (M)
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Address
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City
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Postal Code
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Phone #
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Business #
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The Meditative Warrior
11692 Timberly Ct
Richmond, VA 23238
Tel: 804-909-7380
Email: themeditativewarrior@comcast.net
