10TH PLANET MOUNT PLEASANT MEMBERSHIP AGREEMENT
I , , am enrolling for 10th Planet Mount Pleasant program , for an initial period of _________ months starting on ____/____/____ and will be allowed to participate in the regularly scheduled classes throughout the week as listed on the back of this agreement and pledge to observe the rules and regulations of 10th Planet Mount Pleasant and its instructors. I understand that the schedule is subject to changes, that classes may be cancelled due to special circumstances. If I am paying with credit, I authorize 10th Planet Mount Pleasant to debit my account, listed below, for the amount of the down payment on the date listed above or thereafter. I authorize 10th Planet Mount Pleasant to debit my account on the ______ of each month or thereafter beginning ____/____/____ in the amount of $__________ for a period of _________ month(s).
I understand that I am responsible for making sure that there are sufficient funds in my checking account or credit card on the day scheduled. In the case that a payment is not made or is late, I understand that a penalty fee of $25 will be billed to my account. The authorization is extended by me to 10th Planet Mount Pleasant and/or its authorized agents or firms engaged in the business of processing check and charge card debits. I understand that no payments or fees are refundable and that by signing this agreement I am waiving any free trials that I may be eligible for.
After the initial period, which ends on ____/____/____, I understand the debit and membership will continue on a month-to-month basis at a rate of $__________ monthly, using the billing information provided above, until I give 10th Planet Mount Pleasant 30 days written notice of my intent to cancel. If you (the buyer) choose to end the month to month charging then decide to rejoin later, you will have to sign another contract. If you decide to cancel your account, it is required that you (the buyer) send your cancellation notice by registered or certified mail, return receipt requested, or hand deliver your notice and get a signed statement from an official at 10th Planet Mount Pleasant, acknowledging the receipt of your notice, in order to prove that you did send notice. To cancel your account after the initial period, you MUST follow the above procedure. ________ Member Initials
During the initial period of my contract, in the case that I am unable to attend classes at 10th Planet Mount Pleasant, I understand that I will continue to be billed as agreed upon in this contract. I understand that if I am missing a minimum of one month, I may receive credit for the time that I am gone by either submitting a written letter 7 days in advance, via registered or certified mail, return receipt requested, notifying a representative of 10th Planet Mount Pleasant of the reason I will be gone and the dates of departure and return, or I may hand deliver my notice and get a signed statement
from an official at 10th Planet Mount Pleasant, acknowledging the receipt of my notice. When my contract expires, I understand that the time I have on credit may then be used. ________ Member Initials
You (the buyer) may cancel this agreement by midnight of 10th Planet Mount Pleasant third business day after the date of this agreement. Excluding Sunday or holidays, such cancellation must be in writing, sent registered or certified mail, return receipt requested, or hand delivered to 10th Planet Mount Pleasant, 806 N. Jefferson Mt. Pleasant, TX 75455. If you do hand deliver your cancellation notice, be sure to get a signed statement from an official at 10th Planet Mount Pleasant acknowledging the receipt of your notice. If you miss the initial cancellation period, you may still cancel your contract afterwards by paying one third of the remaining balance – however, any fees already collected are nonrefundable. If your account goes more than 90 days delinquent, you may be sent to collections for the full outstanding amount. You may cancel your membership if you develop a full disability, which prohibits you from utilizing ALL portions of the gym, by having your physician fill out a Disability Form. This form must be emailed directly from the doctor's office in order to be accepted. A doctor's note will not be accepted. For minor injuries, see the paragraph above. You may terminate this agreement in the event that you permanently move your residence more than 50 miles away from any of our locations. For termination due to a permanent move, a written notice of 30 days must be sent to the 10th Planet Mount Pleasant by certified mail with legitimate verification of the move, any fees already collected are non-refundable, and a $100 termination fee will apply. ________ Member Initials
YOUR SIGNATURE REPRESENTS THE FULL UNDERSTANDING OF THIS AGREEMENT.
Printed Name:
Signature:
For student:
RELEASE AND WAIVER OF LIABILITY
I, the undersigned hereby waive all claims against any and all persons associated with 10th Planet Mount Pleasant. I understand that I am participating in a martial art which has body contact. I understand that this form of martial arts involves choke holds, arm locks, neck cranks, ankle locks, throws, slams, punches, kicks, elbows, knees, and such which could potentially cause serious injury or even death. I assume full responsibility for all my actions during and connected to the above organization. I understand the risk of participating in this form of martial arts training and hereby release 10th Planet Mount Pleasant and all of its agents, employees and associates of and from any and all liability, claims, demands, actions, medical bills, and causes of action whatsoever arising out of or
relating to any negligent or other act or omission, and/or any loss, damage, or injury, including death, that may be sustained by the undersigned or any property of the undersigned in participating in this form of training. I, the undersigned also state that I am in good physical condition and know of no reason why I can not train in this form of training. I understand that in case of emergency, I hereby authorize any licensed medical personnel to perform any accepted medical assistance deemed necessary and I agree to bear the expense of any such treatment. As additional consideration for training at 10th Planet Mount Pleasant, I agree that my attendance and/or performance at the academy and abroad at events and such may be photographed, filmed and/or taped and used by 10th Planet Mount Pleasant for marketing purposes and I authorize the use of my image and I waive any compensation thereof – even if I discontinue my training at 10th Planet Mount Pleasant. I acknowledge that I would like to receive correspondence from the academy via telephone, mail, and email. I, the undersigned, being duly aware of the risks and hazards inherent upon participating in this form of martial arts agree to all its rules, terms, and conditions. I acknowledge that I have received a copy of the 10th Planet Mount Pleasant rules and sparring rules, have read them, understand them, and agree to honor and obey them. I understand that disobeying the rules may, at the instructor’s discretion, result in suspension or expulsion from 10th Planet Mount Pleasant and that I will not be entitled to a refund and if expelled must pay the remainder of my contract if one has been signed. In signing the foregoing release, the undersigned hereby acknowledges and represents that he/she has read the foregoing release, understands it and signs it voluntarily; that he/she is over 18 years of age and of sound mind. If under 18, parent/legal guardian in signing this release agrees to all its terms and conditions.
Print Name:
(Parent/Legal Guardian if under 18 years of age)
Signed:__________________________________________ Date:_________________
(Parent/Legal Guardian if under 18 years of age)
Student Uniform:
Kid’s Jiu-Jitsu - Student will need to wear shorts or spats with a t-shirt or rashguard.
Adult’s Jiu-Jitsu – Student will need to wear shorts or spats with a t-shirt or rashguard.
No shoes are allowed on the mats. Socks are permitted.
Instructor Contact Information
Head Coach Tony Oviedo – (903) 466-6434
Coach Gilbert Moore – (903) 808-1444
Feel free to contact coaches with any questions or concerns you may have.