Harbor Membership Signup Interest Form Note: Fields with an * are required. Contract Options $70/12 month Contract$109/Month to MonthStudent Special $75/Month No Contract Primary Member: Primary Member's First Name* Primary Member's Last Name* Primary Member's Phone Number* Primary Member's Email Address* Primary Member's Date of Birth* Address* City* State* Zip Code* Additional Adult or Spouse ($40) Would you like to add an additional adult or spouse to the membership?* (Must be living with primary member.) YesNo Additional Adult's or Spouse's First Name Additional Adult's or Spouse's Last Name Additional Adult's or Spouse's Phone Number Additional Adult's or Spouse's Email Address Add Children ($15/child) Would you like to add children to the membership?* YesNo Child #1 First Name Child #1 Last Name Child #1 Date of Birth Child #2 First Name Child #2 Last Name Child #2 Date of Birth Child #3 First Name Child #3 Last Name Child #3 Date of Birth Child #4 First Name Child #4 Last Name Child #4 Date of Birth Additional Notes Terms and Conditions MEMBERSHIP RIGHT AND PRIVILEGES In consideration of the Membership Fee and MEMBER / MEMBER’S covenant to observe all applicable rules and conditions of membership, CLUB/S hereby grants to MEMBER the right to use and enjoy the facilities and equipment of HARBOR ATHLETIC CLUB INC. located at 2529 ALLEN BLVD., MIDDLETON, Wisconsin, HARBOR WELLNESS CENTER located at 2711 ALLEN BLVD., MIDDLETON, Wisconsin, or any co-facilities throughout the term hereof and to the extent described in CLUB/S Membership brochure and policy booklet, commencing on the date hereof. In the event CLUB/S discontinues any of the program, services or amenities to which MEMBER is entitled at any time during the term of this Agreement, MEMBER shall thereafter be entitled to a proportionate reduction of the Membership Fee, which shall be credited or refunded to MEMBER by CLUB/S. After 12 MONTHS I understand that I may terminate this application with a 30 DAY WRITTEN NOTICE prior to the collection date to CLUB/S and discontinue use of my membership identification card. I understand that if I miss a monthly payment for any reason I may be subject to pay service fee of $20.00/MO. and or an initiation fee to regain membership status. CLUB/S agrees to give 45 days notice of any change in monthly fees after minimum contract terms have been met. I agree to the MEMBERSHIP RIGHTS AND PRIVILEGES.* MEMBER’S INITIAL*: RELEASE FROM RESPONSIBILITY MEDICAL CONDITION, PREMISES AND ENVIRONMENT The above named MEMBER(S) agree to release and discharge CLUB/S and any co-sponsor from any and all claims, actions, suits and demands of any nature arising from any medical condition, accident, incident, collision, or other occurrence, during or in conjunction with my use of the facility and equipment owned and operated by CLUB/S or in conjunction with the condition of the premises in which the above-described activities take place. I acknowledge that it is my responsibility to inspect the premises and equipment where the activity is to take place, and I rely on my own inspection, skill, judgment, and ability in the use of the facility and equipment, not upon such safety precautions as may be taken by CLUB/S and any co-sponsor. Further, I assume all risks of injury while upon the premises while participating in activities. The Above waiver shall not apply to any claim or cause of action resulting from reckless or intentional conduct of the CLUB/S. MEMBER’S DEATH OR DISABILITY In the event of MEMBER’S death or medical disability which prevents MEMBER from making use of the facilities, programs and services normally provided to other persons possessing the same type membership as MEMBER, CLUB/S shall give an appropriate refund to the MEMBER. MISCELLANEOUS a. If any provision in this Agreement is declared invalid or unenforceable, such provision shall be deemed deleted; and the remainder of this Agreement shall be enforced to the full extent permitted by law. b. No waiver of any breach or default by either party shall be deemed a waiver of any subsequent breach or default of the same or similar nature. c. MEMBER / MEMBERS agrees and warrants that the statement and representation made by the MEMBER / MEMBERS in the Application portion of this Agreement are true, accurate and complete and may be relied upon by CLUB/S. d. MEMBER may not transfer or assign membership rights and privileges without the written approval of CLUB/S and payment of the current transfer fee by the assignee. e. The parties agree that this agreement, including the application portion hereof and the CLUB/S membership brochure and policy booklet, constitutes the final written expression of all the terms of this Agreement and constitutes a complete and exclusive statement or those terms. Accordingly, except as provided herein, no representations, promises, warranties or statements by either party which differ in any way from the terms of this written Agreement shall be given any force or effect whatsoever. f. This Agreement shall not become binding upon CLUB/S until it is accepted by the duly authorized representative of CLUB/S at 2529 Allen Blvd., Middleton, WI. I agree to the RELEASE FROM RESPONSIBILITY MEDICAL CONDITION, PREMISES AND ENVIRONMENT.* MEMBER’S INITIAL*: RIGHT TO CANCEL CANCELLATION AND REFUNDS You are permitted to cancel this contract until midnight of the third operating day after the date on which you signed the contract. If the facilities or services that are described in the contract are not available at the time you sign the contract, you have until midnight of the third operating day after the day on which you received notice of their availability to cancel the contract. If, within this time, you decide you want to cancel this contract, you may do so by notifying CLUB/S, by any writing mailed or delivered to CLUB/S at the address shown on the contract, within the previously described time period. If you do cancel, any payments made by you, less a user fee at no more than $3.00 per day of actual use, will be refunded 21 days after notice of cancellation is delivered, and any evidence of any indebtedness executed by you will be canceled by CLUB/S. Arrangements will be made to relieve you of any further obligation to pay the same. I agree to the RIGHT TO CANCEL CANCELLATION AND REFUNDS.* MEMBER’S INITIAL*: Subscribe to Harbor Athletic Emails* Yes, please.No, thanks.