ARC Start Date:

Your Name: (required)

Date of Birth: (required)

Home Address:

Home Phone Number: (required)

Your Email: (required)

Your Employer/School:

Work Phone Number:

Emergency Contact Name: (required)

Relationship to You:

Emergency Contact’s Phone Number: (required)

Emergency Contact’s Employer:

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Yes
No

Do you feel pain in your chest when you do physical activity?
Yes
No

In the past month, have you had chest pain when you were not doing physical activity?
Yes
No

Do you lose your balance because of dizziness or do you ever lose consciousness?
Yes
No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Yes
No

Is your doctor currently prescribing drugs for your blood pressure or heart condition?
Yes
No

Do you smoke?
Yes
No

Are you diabetic?
Yes
No

Do you know of any other reason why you should not do physical activity?
Yes
No

What is your height?

What is your current weight?

Please list any medical conditions you currently have or have been treated for in the past five years:

Please list any current or past injuries:

Are you currently exercising?
Yes
No

Please briefly describe your previous or current exercise history:

Please describe your goals and if there is a target date for attaining them:

Target Date: (required)

How did you hear about ARC Athletics?
Google
Yelp
Bing
Tribeca Tribune ad
Tribeca Citizen ad
ARC customer
a friend
walking by

WAIVER OF LIABILITY
I understand that although ARC Athletics’ programs are designed to provide a safe level of beneficial exercise and enjoyment, there is an inherent risk that participation in such a program may result in injury to me. Therefore, I hereby agree to specifically assume all risk of injury to me while participating in programs at ARC Athletics and I hereby waive any and all claims or actions I may have against ARC Athletics or its owners and employees as a result of such injury.

1. Injuries arising from use of any exercise equipment.

2. Injuries arising from my participation in supervised or unsupervised activities and programs in any areas of the facility.

3. Injuries or medical disorders resulting from exercising at the facility including, but not limited to heart attacks, heat stress, sprains, broken bones, and torn muscles or ligaments.

4. Accidental injuries within the facility.

I also acknowledge the existence and need for Rules and Regulations including those governing use of equipment and facilities and participation in programs and services. I hereby agree to comply with the Rules and Regulations and any further amendments or additions the ARC Athletics decides are appropriate. I understand this application is subject to the review and approval of the facility.

AGREEMENT CONSENT (required)
I agree to the above Waiver of Liability.

PARENTAL CONSENT (if new client is under 18)
As the Parent or Legal Guardian of the above new ARC fitness client, I agree to the above Waiver of Liability.

CANCELLATION POLICY
The cancellation policy for appointments at ARC Athletics is as follows:

Appointments must be canceled 24 hours prior to the scheduled time. You will be charged for a missed session. The policy works both ways, in that, if the trainer cancels within 24 hours, the client gets a complimentary session. If you are late, the time balance of the appointment will be used. You may not receive the entire time if you are late.

Credit Card Number:

Credit Card Expiration Month:

Credit Card Expiration Year:

3-4 digit security code (on back of card):

Policy for Semi-Private Training
We are pleased to offer Semi-Private Training, allowing two people to workout with a trainer at the same time for a reduced rate. The discounted rates are only available if both participants take part in the session. If one client is not available (cancels) for the Semi-Private Session, the remaining participant must either shorten his/her session or pay the Private Training rate.

Referral Program
If you refer us a client, you will receive a complimentary workout session equal that of your referral’s session. This program was initiated in February 2008 and is not retroactive.

Alter-G
The Alter G (Anti-gravity treadmill) is available by appointment only. Sessions are $25/30 minutes, $30/45 minutes and $40/60 minutes. If you pre-pay for 10 you’ll get a FREE extra session. Our cancellation policy applies to the use of the Alter G.

By submitting this ARC Athletics: New Fitness Client Form, you confirm that you have provided accurate information, and agree to the content in this form including our Waiver of Liability, and our Cancellation Policy.