Name * First Name Last Name Email * Phone * (###) ### #### Automatic Recurring Payment Authorization Form * Schedule your payment to be automatically deducted or charged to your Visa, MasterCard, American Express or Discover Card. Just complete and sign this form to get started! Recurring Payments Will Make Your Life Easier: • It’s convenient. • Your payment is always on time (even if you’re out of town), eliminating late charges. Here’s How Recurring Payments Work: You authorize regularly scheduled charges to your debit account or credit card. You will be charged the amount indicated below each billing period. A receipt for each payment will be emailed to you and the charge will appear on your bank statement as an “FulHaus Club.” You agree that no prior- notification will be provided unless the date or amount changes, in which case you will receive notice from us at least 10 days prior to the payment being collected. Please complete the information below: I hereby authorize gluthaus to charge my credit card or debit card indicated above each billing cycle for payment of my gluthaus membership. Such fee shall be charged on the credit card. Credit/Debit Card * Visa MasterCard Amex Discover Credit Card Number * Exp. Date * CVC * Cardholder’s Name * Billing Address * City and State Zip Code Terms / Waiver Liability Agreement READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS In exchange for participation in the activity of online/at home guided workout organized by gluthaus, of 813 Wilcox Ave #103, Los Angeles, California, 90038 and/or use of the property, facilities and services of gluthaus, I agree for myself and (if applicable) for the members of my family, to the following: AGREEMENT TO FOLLOW DIRECTIONS: I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by gluthaus, or the employees, representatives or agents of gluthaus. ASSUMPTION OF THE RISKS AND RELEASE: I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge gluthaus for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of gluthaus, whether caused by the fault of myself, my family, gluthaus or other third parties. INDEMNIFICATION: I agree to indemnify and defend gluthaus against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of gluthaus. FEES: I agree to pay for all damages to the facilities of gluthaus caused by any negligent, reckless, or willful actions by me or my family. APPLICABLE LAW: Any legal or equitable claim that may arise from participation in the above shall be resolved under California law. NO DURESS: I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that gluthaus has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement. ARM'S LENGTH AGREEMENT: This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity. Accordingly, the Parties specifically reject the application of Cal. Civ. Code §1654 to this Agreement, as well as any other statute or common law principles of similar effect. ENFORCEABILITY: The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement. DISPUTE RESOLUTION: The parties will attempt to resolve any dispute arising out of or relating to this Agreement through friendly negotiations amongst the parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure. Any controversies or disputes arising out of or relating to this Agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation does not successfully resolve the dispute, then the parties may proceed to seek an alternative form of resolution in accordance with any other rights and remedies afforded to them by law. Hide me Emergency Contact Person * First Name Last Name Emergency Phone * Relationship to the contact * Waiver Liability Agreement * I HAVE READ THE TERMS & WAIVER OF LIABILITY AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS. Thank you!
