Membership Updates

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First NameLast NamePhone NumberBirthdateE-Mail addressYour Billing AddressEmergency Contact NameEmergency Contact Phone NumberTerms and Conditions I agreeYou consent to receive communications from us electronically. We will communicate with you by e-mail, phone, and SMS. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing. Auto-payments are due on your selected payment day. If a specific day is not specified, your pay date will be this day every month. Example. If you sign this form on 2/13, your autopay day will be the 13th of every month. All cancellations require 30-day written notice for cancellation, via our cancellation link provided by staff. Taxation by state may vary, price is displayed without tax (tax will be applied upon completion of purchase) on merchandise. Memberships, personal training and other services are not taxed. I authorize * operating by license under BOXSTL to initiate transfers, whether through my credit card company or EFT/ACH transfer, from the designated account indicated above for the purpose of paying, initial payment and on a recurring basis, all portion of the dues, fees and charges which I owe under this agreement. I also authorize * operating by license under BOXSTL to initiate, if necessary, debit entries and adjustments for any credit entries made in error.Cardio courses and Sparring and other, offered by BOXSTL , an independently owned and operated , and its owners, employees, and instructors (collectively “Fitness Center”) could involve physical contact with other individuals and/or heavy bags, which may result in personal injury. Other programs offered by the Fitness Center, including weight lifting, aerobics and other events also present a risk in personal injury to the participant (you). In consideration of mutual agreements by which I will use the premises of BOXSTL, which I acknowledge to be beneficial to me, I acknowledge and agree to the following:I warrant and represent that I am in appropriate physical condition for the physical activities in which I will participate and that such physical activities, even noncontact activities, carry a risk of serious physical injury including substantial and permanent injuries, and/or death, and I knowingly and voluntarily assume those risks and waive in advance any claim of liability resulting from those risks. On my own behalf and on behalf of my representatives, my estate, and all persons claiming through me directly or derivatively, I hereby agree to hold harmless, release, and discharge in advance BOXSTL and their respective owners, officers, members, employees, affiliate companies, and all other participants and nonparticipants associated with those identified entities from any injury that I may receive whether or not from the negligent or intentional acts of those persons released. Furthermore, I agree on my own behalf and behalf of my representatives, estate, successors and assigns to defend BOXSTL from and against any and all claims and liability that may arise by reason of any injury or death I may sustain from participation in physical activities at the facilities of the BOXSTL, whether caused by an intentional act, or by negligence, or otherwise without limitation. This agreement to defend includes any claim, action or liability whatsoever, regardless of whether the claim is made, without limitation, by me, by someone on my behalf or by someone whose claim is derived from my injury or death. I acknowledge and agree (1) that it is my responsibility to cover any medical bills that I may incur and to cover myself with any medical insurance I may deem appropriate and (2) that I will not and cannot make any claim for medical coverage resulting from any injury or death incurred by me at the facilities of BOXSTL shall not be liable for any loss or theft of my personal property. I also specifically agree that BOXSTL shall not be responsible for all such personal or property injuries, damages, loss or theft, even in the event of negligence, fault or failure to use due care on the part of BOXSTL , and whether such negligence, fault, or failure to use due care is present at the signing of this Agreement or takes place in the future. I hereby consent to BOX STL taking photographs or video images of me while in classes or otherwise in the public premises of BOX STL and hereby irrevocably grant BOX STL the right to use my image or likeness in such images or photographs in any advertising, promotion, marketing materials including any and all social media, print media, or on BOX STL website.Signature