Complete the registration form below to proceed.Name of Member* First Last Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone*CellEmail* Date of Birth* Date Format: MM slash DD slash YYYY Please enter your Student ID # if you have oneIs your existing membership active?*YesNoUnsurePlease do not proceed with this form if you are unsure if you have an active membership. Please contact us to confirm.Do you have a Key Fob?*YesNoWhat is your Key Fob # ?*If you can't read the number, please call in to arrange a replacement.Add New Key Fob*Include Key Fob - $20 (After you have submitted this application - call 519.401.4633 to arrange pickup)Please upload an image of a void cheque or a pre-authorized payment form from you banking institution.* Pre-authorized payments, as per the following agreement:Minimum non-cancelable 12 month commitment, then month to month until terminated by member, paid by pre-authorized bank withdrawal on the 1St day of each month. In the event of plan non-payment, management reserves the right to place the entire account with a collection agency. A $25.00 NSF fee will apply each time a bank item is returned. PRIOR TO EXPIRY OF THE PRE-AUTHORIZED PAYMENT PLAN ANNUAL TERM, YOU WILL BE NOTIFIED IN WRITING BY MAIL, TEXT OR EMAIL, 30 — 90 DAYS IN ADVANCE, ABOUT THE RENEWAL OR EXTENSION. THIS AGREEMENT WILL NOT BE RENEWED OR EXTENDED IF YOU NOTIFY US WITHIN THE INITIAL 12 MONTH TERM. UPON EXTENSION OF THE INITIAL 12 MONTH TERM, MEMBERS WILL BE PLACED ON A MONTH TO MONTH AGREEMENT. ONE FULL MONTH'S NOTICE IS REQUIRED TO CANCEL. NOTE: All members have access to use all of the gym equipmentI have read the Access Rules, Liability Waiver and My Rights under the Consumer Protection Act, 2002 as shown below:* I agreeACCESS RULES 1. It is agreed that you will not permit access to the gym understood to any other person. It is understood that all other members are able to access the Gym without your assistance 2. You will not bring any person, who is not a member of this Gym, onto the premises without permission, including family members, friends, relatives or work associates. 3. Members found to be abusing the spirit of this agreement may have their membership revoked without refund. LIABILITY WAIVER 1. Neither the Power Fitness Gym nor any of its members will assume any responsibility for injury or accident that may our to you while on or about these premises, however caused. 2. Use of equipment and facilities is entirely at your own risk. Gym management will not warrant that all equipment is safe and free of defects at all times. If you do not believe a piece of equipment is safe, you agree to report it and DO NO USE IT. 3. While exercise is generally important for good health, there are those who should consult their Doctor or other medical professional prior to undertaking physical activities. It is entirely your responsibility to ascertain the need for this advice prior to beginning fitness activities. 4. We recommend that you arrange with another gym member to work out in a team environment for health and safety reasons. Should you choose to do otherwise, this is entirely at your own discretion and any resulting injuries or accidents are your responsibility. 5. Rules of general application will be posted and may change from time to time. In the interests of health and safety, and general consideration for others, you agree to abide by these rules and understand that failure to do so may result in the termination of membership without refund by Gym Management. 6. You are expected to pick up all weights when finished; to place all clothing and excess footwear in designated areas; to exercise with a shirt on and shoes on at all times; to wipe equipment after use; and to refrain from using foul language. Even so, Gym Management cannot ensure that people will always behave in an appropriate manner. If you are concerned, you should leave the premises and report the incident to Gym Management. Should you choose to not report the occurrence and stay at the Gym, any injuries or accidents to you are your responsibility. 7. The Gym is not responsible for the loss, damage or theft of personal property belonging to members. YOUR RIGHTS UNDER THE CONSUMER PROTECTION ACT, 2002 You may cancel this agreement at any time during the period that ends ten (10) days after the later of the day you receive a written copy of the agreement and the day all the services are available. You do not need to give the supplier a reason for cancelling during this 10 day period. In addition, there are grounds that allow you to cancel this agreement. You may also have other rights, duties and remedies a t law. For more information, you may contact the Ministry of Consumer and Business Services. To cancel this agreement, you must give notice of cancellation to the supplier, at the address set out in the agreement, by any means that allows you to prove the date on which you gave notice. If no address is set out in the agreement, use any address of the supplier that is on record with the Government of Ontario or the Government of Canada or is known to you. If you cancel this agreement, the supplier has fifteen (15) days to refund any payment you have made and return to you all goods delivered under a trade-in arrangement (or refund an amount equal to the trade-in allowance). If the supplier requests in writing repossession of any goods that came into your possession under the agreement, you must return the goods to the supplier's address or allow one of the following persons to repossess the goods at your address: The supplier or a person designated in writing by the supplier. If you cancel this agreement, you must take reasonable care of any goods that came into your possession under the agreement until one of the following happens: The supplier repossesses the goods. The supplier has been given a reasonable opportunity to repossess the goods and twenty-one (21) days have passed since the agreement was cancelled. The supplier directs you in writing to destroy the goods and you do so in accordance with the supplier's instructions. You return the goods.CommentsThis field is for validation purposes and should be left unchanged.