MELT Sign Up Form Name (First,Last) Date of Birth (yyyy/mm/dd) Address Email Phone Do you have any specific medical conditions such as heart disease, asthma, diabetes, epilepsy, joint or muscular injuries? Please list your medical concerns and any medication or supplements including frequency and purpose. In the past 6 months, how often have you engaged in physical activity? Regularly (3-4x/week) Semi regularly (1-2x/week) Sporadically (1-2x/month) Why have you decided to participate in a MPF program? Need motivation and accountability Improve physical fitness & strength Weight loss/management Post rehabilitation training Boredom with current routine Other Maximum Performance & Fitness MELT Contract:This CONTRACT, WAIVER, AND RELEASE (this “Agreement”) constitutes a contract between the undersigned (“Participant”) and Maximum Performance & Fitness, LLC and Brad Nordstrom (collectively, “MPF”) with respect to participation in the MELT program administered by MPF. By signing below, Participant agrees as follows:1. Price and Payment:Monthly payment: Participant agrees to pay MPF on a monthly basis consistent with MPF’s current pricing. As of the date of this Agreement, monthly pricing is as follows for a six month commitment (check a plan): Unlimited Sessions - $139/month Unlimited College Student - $90/month 12 sessions per month - $119/month 8 sessions per month - $99/month 4 sessions per month - $59/month • Automatic renewal: I understand that after my initial six month commitment, my membership will automatically renew for another month at the same price, subject to any price changes as described herein. • Price changes: I understand that following the initial six-month commitment MPF reserves the right to raise its prices on 30-days written notice. • Payment timing: I understand that payment is required by the 1st or 15th of each month and in advance of new monthly training sessions. • Cancellation: I understand that I may terminate the program by signing the membership cancelation agreement and turning back my key fob at any time following the completion of the initial six month commitment after notice to MPF at least 10 days before the next scheduled EFT funds draw date. • Refunds; missed sessions: I understand that there are no refunds for sessions that are not completed, including following cancellation of the program. Missed sessions cannot be made up in the following months. 2. Conduct. I understand and agree that I must act in a careful, respectful, controlled and appropriate manner while participating in the exercise training session/class and/or using the equipment provided. I further understand and agree that MPF has the right to ask me to immediately discontinue participation in these activities if I am acting in a manner that is deemed inappropriate or for any other reason. 3. Media Release. I understand that MPF may wish to use photographs and/or video images of me on MPF’s websites, in email, in videos, on social media, in printed brochures and in similar communications and marketing materials. I hereby grant MPF a royalty-free, perpetual, license and right to use, copy, distribute, and edit such images. I understand and agree that no compensation or royalty of any kind is due to me for use of such images. To opt out of this license, I must provide written notice to MPF. 4. Nutrition coaching. I understand that MPF may from time to time provide advice, or sell products, related to nutritional recommendations, nutritional programs, and/or dietary supplements. I understand that MPF does not have a Licensed Nutritionist or a Registered Dietician on staff. I agree to waive any claims against Brad Nordstrom and MPF regarding any such nutritional advice. 5. Medical insurance. I understand the medical risks involved with physical activity and the need for medical insurance. I have a medical insurance policy, and such insurance will be my source of payment should medical treatment be necessary. 6. Health acknowledgment. I am aware that vigorous physical exercise strains the cardiovascular and muscular systems and other parts of my body and can be a hazardous activity. I am voluntarily participating in use of any equipment and exercise instruction with knowledge of the danger involved and hereby agree to accept any and all risks of injury or death. I understand that I should consult a physician prior to starting a fitness and exercise program. Waiver and ReleaseOn behalf of myself and anyone who has or obtains legal rights or claims through me, I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO HOLD HARMLESS, Brad Nordstrom, Maximum Performance & Fitness, LLC, and all of and their employees, agents, officers, directors, and assigns from all liability, claims, demands, losses, or damages I may have as a result of my participation in activities associated with personal training, group training, fitness instruction, or nutrition coaching. I ALSO HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO HOLD HARMLESS Brad Nordstrom, Maximum Performance & Fitness, LLC, and all of and their employees, agents, officers, directors, and assigns for any act or omission relating to nutritional advice or nutritional guidance provided to me. I understand that I am signing a legal contract and that I am legally bound by its content. By typing my name, below, I am agreeing to all terms in this Agreement. I recognize that this electronic signature has the same force and effect as a manual signature and my execution of this electronic signature constitutes my valid and binding signature for all purposes. Submit