1 DAY PASS

PRINT OUT, FILL IN THIS FORM,  BRING TO THE GYM FOR FREE 1 DAY PASS    (See restrictions below)

GUEST INFORMATION

DATE:____________________

Name:_____________________________________________________

Street address:______________________________________

City, State,Zip_________________________________________

Phone:_________________________________

E-Mail Address:______________________________________________

DOB:_______________________

How did you hear about us?_________________________________________

Do you have any health issues?     Yes      No

If yes, please specify_______________________________________________

I accept full responsibility for my use of any and all apparatus, facility privilege or service whatsoever, owned and operated by the Fitness Factory at my own risk and shall hold this club, its shareholders, directors, officers, employees, representatives and agents harmless from any and all loss, claim, injury, damage liability sustained or incurred by me resulting there from.

Signature:


(For insurance purposes we are required to have all persons sign this form)

*Must be over 21, local resident, have photo I.D., have not used the Fitness Factory in previous 12 months, other restrictions may apply.