PRMAA Waiver & Terms Pacific Rim Martial Arts Academy waiver and acceptance of terms. This form MUST be fully completed prior to participating in any PRMAA classes. Step 1 of 3 33% PRMAA Membership*Welcome to the Pacific Rim Martial Arts Academy. Before participating in any event, class, or activity, you must first complete and submit this form in it's entirety. You may complete this form for yourself and any immediate family members who are part of your membership. Before completing the form, please indicate whether you are a new or returning member of PRMAA, or whether you are attending an event.New MemberRenewing MemberEventEnrollee Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Date of Birth* Date Format: MM slash DD slash YYYY Age*Please enter a number less than or equal to 100.Gender* Male Female Primary Phone*Alternate PhoneEmail* Employer Occupation Friend or relative not living with you:* First Last Phone number for contact above:*OPTIONAL: Use the fields below to add additional family members to your membership.Name First Last Date of Birth Date Format: MM slash DD slash YYYY AgePlease enter a number less than or equal to 100.Gender Male Female OPTIONAL: Add a family memberName First Last Date of Birth Date Format: MM slash DD slash YYYY AgePlease enter a number less than or equal to 100.Gender Male Female OPTIONAL: Add a family memberName First Last Date of Birth Date Format: MM slash DD slash YYYY AgePlease enter a number less than or equal to 100.Gender Male Female WAIVER The agreement entered into on the date shown below by and between Pacific Rim Martial Arts Academy Incorporated (Pacific Rim) and the Enrollee is as follows: PRIMARY MEMBER INFORMATION MEMBERS’ RIGHT TO CANCEL: If you wish to cancel this contract, you may cancel by delivering or mailing a written notice to Pacific Rim. The notice must say that you do not wish to be bound by the contract and must be delivered our mailed before midnight of the third business day after you sign this contract. The notice must be delivered to: Pacific Rim Martial Arts Academy, 8970 SW Burnham St. Tigard, OR 97223. If you cancel, Pacific Rim will return, within 10 business days of the date on which you give notice of cancellation, any payments you have made. CANCELLATION POLICIES (1) If during the original terms of this contract you relocate more than a 15 mile radius from Pacific Rim, you may cancel this contract by providing a 30-day written notice and proof of relocation. Any pre-paid dues remaining will be refunded, except for a cancellation fee not to exceed $50. Acceptable proof of relocation includes a newly issued Driver’s License with an address different from the one you signed up with or shown on your previous license or a utility bill in your name with your new address. (2) If you die or become totally and permanently disabled, you or your estate may cancel this contract by providing a written request and certifiable proof of disability or death. For permanent disability, your doctor must prove certification of the disability and state that you are unable to perform any of the exercises at Pacific Rim during instruction. Any pre-paid dues remaining will be returned but no cancelation fee will be charged. (3) Pacific Rim retains the right to cancel or suspend the membership of any person for any reason. If such cancellation or suspension is made due to a violation of Pacific Rim policies, violation of terms of this contract or due to damage rendered by you or your guests, you will remain responsible for the financial obligations of this contract as well as a $50 cancellation fee. (4) If Pacific Rim goes out of business or moves its facilities more than 5 miles from its present location, Member may cancel by written notice. Any cancellation under this subsection will receive a pro-rata refund of any prepayments. Any payments due prior to cancellation taking effect will still be due and payable. Your account must be current before any cancellation will take effect. To cancel for any of the above reasons, send or deliver a written notice to Pacific Rim or designated billing company. ADDITIONAL TERMS AND CONDITIONS DEFAULT AND LATE PAYMENTS: Should you default on any payment obligation called for in this agreement, Pacific Rim will have the right to declare the entire remaining balance due and payable and you agree to pay allowable interest and all costs of collection, including but not limited to collection agency fees, court costs, and attorneys fees. A default occurs when any payment due under this agreement is more than ten days late. A SERVICE FEE WILL BE CHARGED IMMEDIATELY FOR ANY CHECK, DRAFT, CFREIT CARD, OR ORDER RETURNED FOF INSUFFICIENT FUNDS OR ANY OTHER REASON. SHOULD ANY MONTLY PAYMENT BECOME MORE THAN 10 DAYS PAST DUE, YOU WILL BE CHARGED A LATE FEE. RIGHT TO DESIGNATE AND/OR CHANGE BILLING COMPANY: Pacific Rim hereby reserves the right to designation and/or change the designated billing company at their discretion and without warning. If such a change is made, the full terms and conditions of this agreement will continue to apply and you agree to authorize the new billing company to continue to charge your account. NOTICE: ANY HOLDER OF THIS AGREEMENT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT HERETO OR WITH THE PROCEEDS HEREOF, RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER. MEMBERSHIP FREEZE POLICY: If you have a term membership (i.e. 12-months) you may freeze time on your membership for a medical reason. Freezes can be from 30-90 days at a time. We may ask for documentation to verify your situation. Freezing time on your membership does not stop your membership payments. You are still liable for your original payment schedule. Once you resume any usages of Pacific Rim, the freeze will terminate. Time of any freeze will be credited to the end of your membership’s original term. Military Member: If at anytime during the term of your agreement, you are deployed or assigned to active duty, Pacific Rim will allow you to freeze your membership for the time in which you are absent upon written request from you. You will need to provide proof of deployment or assignment detailing your absence and the applicable time period. HOLIDAYS / MAINTENANCE OF FACILITIES: Pacific Rim may be temporarily closed for periods of up to two weeks for annual maintenance and/or holidays, including but not limited to Christmas, Thanksgiving, Labor Day, Memorial Day and Independence Day. MEMBER OBLIGATIONS: (1) Member agrees to abide by all Pacific Rim policies, follow the directions of the staff regarding safety and security issues, and to treat the staff and other members with courtesy and respect at all times. (2) Member agrees to pay monthly dues on time, including notifying Pacific Rim if banking or credit card information used for automatic payment changes, or to be charged a declined payment fee and/or late fee per delinquent payment. (3) Member agrees to pay all costs of collection incurred by the holder of this agreement if this account becomes more than 60 days past due. (4) Member agree to continue to fulfill the financial obligation of this agreement, except as allowed below. SUMMARY OF MEMBERSHIP POLICIES 1. Member agrees to abide by all membership regulations and policies of Pacific Rim. Member agrees to comply with states and customary rules for participation and use of equipment. Unless cancelled as provided in this agreement, Member will be responsible for all payments due and owning under this agreement, even if Member does not use the facilities or attend classes. If Pacific Rim becomes temporally unavailable due to an event such as fire, flood or the like, we will extend the Member’s membership for the period the facilities were unavailable. 2. If Member violates this agreement and the terms contained therein or any of the rules for use of the facility, Pacific Rim may suspend the Member’s right to use the facility until such time as the Member provides Pacific Rim with reasonable assurance of future compliance. During the period of any such suspension, the Member shall not be entitled to a credit for a prepayment of dues or other fees. In the event Member’s membership is terminated by Pacific Rim for said violations, the balance of the contract will be declared due and payable in full immediately. 3. Member agrees to abide by Pacific Rim dress code at all times while in the facility. Member agrees that Member will not use loud or profane language upon the premises, not shall Member molest, badger, assault or harass other Pacific Rim members, guests, employees or contractors. If Member engages in such behavior, Member’s membership shall be subject to immediate cancellation and the balance of the contract declared due and payable in full immediately. 4. Member understands Member will be photographed at Pacific Rim. By execution of this agreement, Member agrees to allow Member’s photo, video or film likeness to be used for any legitimate purpose by Pacific Rim and its respective producers, sponsors, organizers and/or assigns, in their discretion. Member acknowledges that by signing this agreement, Members gives up all claims of ownership, income, editorial content and use of such media, and assigns all copyright ownership to Pacific Rim Martial Arts Academy, LLC. 5. Member agrees that if Member fails to use Pacific Rim facilities or equipment or fails to attend classes that shall not release Member from the obligation to make all payments required by the terms of this Membership Agreement. 6. Arbitration: All disputes (except small claims under $1,000) will be settled binding arbitration before a single arbitrator undertake authority of the Federal Arbitration Act, conducted by and in accordance with the rules and procedures of the American Arbitration Association. The arbitration will take place in the county in which Pacific Rim is located unless otherwise agree. All arbitration proceedings must be made by an individual claimant, and will not be conducted on a “class” basis. The decision of the arbitrator must be a reasoned award. The decision of the arbitrator will be final and binding on all parties and may be enforced by a judgement enter up on the arbitration award by any state or federal court in this state. Any award from the arbitrator may be appealed under the Appellate Arbitration Rules of the American Arbitration Association. 7. This agreement may not be amended or modified except by an instrument in writing executed by the parties hereto. 8. Member authorizes Pacific Rim and their authorized designees to contact them by email, telephone, or by other means. Subject to applicable law, Member agrees that any of these parties my contact Member at any mailing address, phone number or email address set for on the face of this agreement, or any other address subsequently provided to, or obtained by, any such party. 9. Pacific Rim retains the right to modify these policies without warning. Reasonable rules and regulation may be posted at Pacific Rim from time to time and all Members shall be subject to strict compliance therewith. SAFETY NOTICES 1. The facility is under 24-hour recorded video surveillance, which may be retained by Pacific Rim for subsequent review. 2. Private lessons and any other personal training services provided at the facility may only be provided by approved instructors of Pacific Rim. All payments for personal training services are to be made to Pacific Rim, who will pay the instructors as the services are provided. 3. Member is required to use facility and all equipment in a safe and approved manner. If Member is unsure how to use or operate any of the equipment, it is the Member’s responsibility to request instruction from approved instructors or staff. 4. Horseplay, vulgar language, abuse of facilities, training in an unsafe manner, training while intoxicated, or other inappropriate behavior will not be tolerated and may result in the suspension or cancellation of the Member’s membership, and the balance of the contract being declared due and payable in full immediately. 5. Cell phones are not permitted in the main training area. Photography and/or videography are not allowed anywhere in Pacific Rim. By checking the box, I agree to the terms set forth in the above Waiver.* I agree. MEDICAL HISTORYGeneral Health:* Excellent Good Fair Poor Date of last physical exam:* Date Format: MM slash DD slash YYYY Medical Problems?* Yes No If "Yes" above, please explain:Taking Medication?* Yes No If "Yes" above, please explain:Additional medical information you want to disclose:ASSUMPTION OF RISK AND RELEASE*I understand their is a risk of personal injury involved in the course of instruction and with this knowledge I hereby release, indemnify and hold harmless Pacific Rim Martial Arts Academy, Inc., SISU Consulting Company, its affiliates, and the owners of Pacific Rim as well as all sponsors, advertisers and their respective officers, affiliates, agents, employees and contractors with respect to any and all injury, disability, death, loss or damage to person or property that may arise out of connection with the instruction I receive and/or my performance of the exercises, including use of any equipment and or machines in the facilities or any indoor or outdoor exercise program or activities offered by Pacific Rim Martial Arts Academy. Due to the physical demands of class instruction, I understand that I must be in good physical condition to participate in said course of instruction and hereby certify that I am in good physical condition. I expressly agree that this release is intended to be as broad and inclusive as permitted by applicable law and if a portion of this release is held invalid, the balance shall remain in full force and effect. This release shall apply to my heirs, assigns, personal representatives and any other next of kin. I understand that Pacific Rim Martial Arts Academy is relying on this release in agreeing to enter into this agreement. I AGREE TO THE ASSUMPTION OF RISK AND RELEASE NameThis field is for validation purposes and should be left unchanged.