Family Fitness Membership Contract Esign


 

Member Information

First Name:    *Required

Last Name:    *Required

Date of Birth:   *Required

Gender:

  *Required

Oneida Enrollment # (If applicable):  

Address

Street:  

City:  State:   Zip:  

Contact Information

Home or Mobile #:  

Work:  

Email:  

Oneida Employment Information (IF APPLICABLE)

Employee #:   Department:   Division:  

Emergency Contact

Emergency Name:  

Emergency Phone #:  

Emergency Work #:  

I, the undersigned, hereinafter called "Member", do hereby enter into this contract for fitness center services with Oneida Family Fitness, and by my signature below understand and agree to the terms of this contract.

Contract Type:

   *Required

Membership Type:

    *Required

Individual provides you access to Oneida Family Fitness facility located at 2640 West Point Road, Green Bay, WI 54304. Family provides you access to Oneida Family Fitness facility located at 2640 West Point Road, Green Bay, WI 543047 plus extends benefits to a second adult and children ages 14-17 years old that live in the same household.

Family Members (IF APPLICABLE)

For each family member, please fill out the following PDFs, save, and upload them.

Physical Activity Readiness Questionnaire Fill-In

Family Fitness Health History Fill-In

Adult #2

Name: Relation: Date of Birth:   

Gender:

 

Oneida Enrolled:

 

Oneida Employee:

 

Physical Activity Readiness Questionnaire Fill-In

Physical Activity Readiness Questionnaire Upload:

Family Fitness Health History Fill-In

Health History Upload:

Child #1

Name: Relation: Date of Birth:  

Gender:

 

Oneida Enrolled:

 

Oneida Employee:

 

Physical Activity Readiness Questionnaire Fill-In

Physical Activity Readiness Questionnaire Upload:

Family Fitness Health History Fill-In

Health History Upload:

Child #2

Name: Relation: Date of Birth:  

Gender:

 

Oneida Enrolled:

 

Oneida Employee:

 

Physical Activity Readiness Questionnaire Fill-In

Physical Activity Readiness Questionnaire Upload:

Family Fitness Health History Fill-In

Health History Upload:

Child #3

Name: Relation: Date of Birth:  

Gender:

 

Oneida Enrolled:

 

Oneida Employee:

 

Physical Activity Readiness Questionnaire Fill-In

Physical Activity Readiness Questionnaire Upload:

Family Fitness Health History Fill-In

Health History Upload:

Child #4

Name: Relation: Date of Birth:  

Gender:

 

Oneida Enrolled:

 

Oneida Employee:

 

Physical Activity Readiness Questionnaire Fill-In

Physical Activity Readiness Questionnaire Upload:

Family Fitness Health History Fill-In

Health History Upload:

Child #5

Name: Relation: Date of Birth:  

Gender:

 

Oneida Enrolled:

 

Oneida Employee:

 

Physical Activity Readiness Questionnaire Fill-In

Physical Activity Readiness Questionnaire Upload:

Family Fitness Health History Fill-In

Health History Upload:

 

Health History

I have, or have had, the following medical conditions which may affect my ability to utilize Oneida Family Fitness' facilities:

If you have had surgeries or use medication, please explain:

 

Do you smoke or use tobacco products?

 *Required 

Do you have other medical conditions which may limit or prohibit utilizing the Oneida Family Fitness facility? 

 

Physical Activity Readiness Questionnaire

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 54, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 55 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions and answer each one honestly: Check YES or NO. *All are required

 Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do your ever lose consciousness?
Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

 

MEMBERSHIP FEE:

Annual: Member agrees to pay a membership fee , if applies, annually at renewal. Failure to pay renewal fee within said date shall result in the cancellation of this contact. Oneida Family Fitness reserves the right to increase the renewal fee upon 30 days notice to Member.

MEMBER GUIDE: Oneida Family Fitness operates facilities as described in the Member Guide, which may from time to time be amended to accurately reflect the nature of facilities offered. All services described in the Member Guide are available at the time of signing of this contact and may be utilized by the Member. By signing below, Member(s) acknowledges receipt of the Member Guide and agrees to be bound by terms and conditions contained within, and acknowledges a continuing responsibility to monitor the Member Guide for changes.

RIGHT TO CANCEL: You are permitted to cancel this contract until midnight of the 3rd operating day after the date on which you signed the contract. If within this time period you decide you want to cancel this contract, you may do so by notifying Oneida Family Fitness in writing, by mail or hand delivery to Oneida Family Fitness, PO Box 365, Oneida, WI 54155, within the previously described time period.
If you do cancel, any payments made by you, less a user fee of no more than $3.00 per day of actual use, will be refunded within 21 days after notice of cancellation is delivered, and any evidence of any indebtedness executed by you will be canceled by Oneida Family Fitness and arrangements will be made to relieve you of any further obligation to pay the same. Joiner fees are not refundable.

INFORMED CONSENT AND RELEASE: Member, and any person listed in Section 2 of this contract, warrants and represents that he or she has no disability, impairment or ailment preventing him or her from engaging in active or passive exercise or that will be detrimental to his or her health, safety, or physical condition if he or she does so engage or participate. Member, or any person listed in Section 2 of this contract acknowledges that there are inherent risks involved in the use of the Oneida Family Fitness and assumes all risks associated with the use of the Oneida Family Fitness facilities. Oneida Family Fitness and the Oneida Tribe of Indians will not be held liable for any claim, demand, injuries, damages, actions, or causes of actions whatsoever to member, guest or property in connection with the use of Oneida Family Fitness. Member, and any person listed in Section 2 of this contract hereby releases and discharges Oneida Family Fitness from all such claims, demands, injuries, action or causes of action.

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Family Fitness Membership Contract Esign
lock iconUnique Document ID: c9cc9523c85395f42aa1918810fb99af28271d63
Timestamp Audit
April 12, 2021 9:30 am CSTFamily Fitness Membership Contract Esign Uploaded by Oneida Nation - webmaster@oneidanation.org IP 74.62.93.29
May 6, 2021 11:41 am CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
May 6, 2021 11:45 am CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
May 6, 2021 11:46 am CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
May 6, 2021 11:52 am CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
May 6, 2021 11:56 am CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
May 6, 2021 1:12 pm CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
August 5, 2021 4:20 pm CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
August 5, 2021 4:21 pm CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
August 6, 2021 9:13 am CSTFamily Fitness - familyfitness@oneidanation.org added by Oneida Nation - webmaster@oneidanation.org as a CC'd Recipient Ip: 74.62.93.27
Audit trial Qr code
This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://oneida-nsn.gov/
Audit Trail Serial# 9711767446559870a5d062bb15f32912