Enrollment Form:

https://form.jotform.com/253254582391056

VIBRATION FITNESS STUDIO

MEMBERSHIP ENROLLMENT FORM

1. Member Information

Full Name: ___________________________________________
Date of Birth: ____ / ____ / ______
Phone: ______________________________________________
Email: _______________________________________________
Address: _____________________________________________
City: __________________ State: ______ Zip: _______________

2. Emergency Contact

Name: _________________________________________________
Relationship: ___________________________________________
Phone: ________________________________________________

3. Membership Type

☐ Monthly Unlimited
☐ 8 Sessions / Month
☐ Drop-In Session
☐ Private Training Add-On
☐ Senior / Mobility Package (Low-Impact)
☐ 6-Month Prepaid
☐ Annual Plan

Start Date: ____ / ____ / ______


Optional Add-Ons:
☐ Progress Tracking App Access

4. Health & Wellness Screening (Required)

Please answer truthfully to ensure safe use of vibration fitness equipment.

Do you currently experience any of the following?
☐ Cardio conditions or pacemaker
☐ Severe joint issues
☐ Vertigo or dizziness
☐ Severe migraines
☐ Recent surgery (last 12 weeks)
☐ Pregnant or possibly pregnant
☐ Uncontrolled high blood pressure
☐ Other health concerns: ________________________________

Have you been cleared by a physician to participate in low-impact vibration exercise?
☐ Yes ☐ No

5. Liability Waiver & Assumption of Risk

I acknowledge that participation in vibration fitness training involves physical activity and inherent risks. I agree that:

  1. I am voluntarily participating in this fitness program.

  2. I assume all risks of injury or health complications.

  3. The studio, its owners, staff, and affiliates are not liable for injuries, accidents, or health events.

  4. I agree to follow all safety instructions and equipment guidelines.

  5. I will disclose any medical concerns prior to participation.

Member Signature: __________________________________
Date: ____ / ____ / ______

6. Media & Results Consent (Optional)

☐ I grant permission for the studio to use my photo, progress results, or testimonials for marketing purposes.
☐ I do not grant permission.

Signature: _____________________________________________
Date: ____ / ____ / ______

7. Membership Payment Authorization

Name on Card: ________________________________________
☐ Visa ☐ Mastercard ☐ Amex ☐ Discover

Card Number: ________________________________________
Expiration: ____ / ____
CVV: _______

☐ I authorize monthly recurring payments until canceled in writing.
☐ I understand there are no refunds on prepaid plans.
☐ I agree to a 30-day written cancellation notice.

Billing Address:

Signature for Authorization: ______________________________
Date: ____ / ____ / ______

8. Studio Policies

  • All sessions must be booked in advance.

  • Late arrivals may reduce session time.

  • Clean athletic shoes required.

  • No food or drinks on equipment.

  • Notify staff immediately if feeling dizzy, light-headed, or uncomfortable.

  • Membership may be suspended or terminated for safety violations.

I acknowledge that I have read and agree to all studio terms.

Signature: _____________________________________
Date: ____ / ____ / ______