New International Karate LLC 7042-B Market Street Wilmington NC 28403

(407) 756 - 9837

MEMBERSHIP AGREEMENT
Name________________________________Gender____Date of Birth____________________
Address______________________________ City ________________State____ZIP__________
Home Phone_______________Other Phone_________________Employer_________________
Emergency Contact________________________________________Phone_________________
How did you hear about the fitness center?________________ Email:_____________________
MEMBERSHIP FEES
Program Fee
Paid Today:

$________________________________

EFT or Credit Card

_____________Enrollment Fee
_____________Current month pro rate, and payment for the month of _______
_____________Subtotal
_____________Total Paid today via:_____Cash_____Check
AGREEMENT FOR EASY PAY DEBIT SYSTEM

I authorize New International Karate Shieijyuku LLC to bill my bank account or credit card for my dues by
electronic funds transfer (EFT), pre-authorized check or credit card charge. Our dues are processed by Twin Oaks
Software Development, a $20 service fee will apply to all delinquent accounts. Your account will be billed upon
minimum participant requirements. Member Initials___________ (Must be initialed by the person who is
providing the payment method.)
The club will bill your (please circle):

Visa

MC

Discover

AMEX

Checking

Savings

Bank name________________________________Routing #_______________________

Account #_______________________________Credit card Exp date________________
Name as it appears on the check/credit card______________________________
PLEASE ATTACH VOIDED CHECK IF APPLICABLE
BUYERS RIGHT TO CANCEL
If you wish to cancel this contract, you may cancel by mailing a written notice by certified or registered mail to the
club. The notice must say that you do not wish to be bound by this contract and must be delivered or mailed before
midnight of the third business day after you sign this contract. This notice must be delivered to New International
Karate Shieijyuku LLC.Wilmington, NC. You may also cancel this contract if you relocate your residence further
than twenty-five miles from any club operated by the seller. This contract may also be cancelled if you die. If you
become disabled, you shall have the option of (1) being relieved of liability for payment on that portion of the
contract term for which you are disabled, or (2) extending the duration of the original contract at no cost to you for a
period equal to the duration of the disability. You must prove such disability by a doctor's certificate, which
certificate shall be enclosed with a written notice of disability sent to the club. The club may require that you be
examined by another physician agreeable to you and the club at its expense. If you cancel, the club may keep or
collect an amount equal to the fair market value of the services or use of the facilities that you have already received.
I hereby acknowledge that I have read and understand this Membership Agreement and Buyers Right to cancel and
that I have received a signed copy of this contract.
_________________________________________
Signature of Member
Date

_________________________________________________
Authorized Staff Signature
Date

Signature of Parent or Guardian if under 18 years of age_______________________________ Date:___________

IMPORTANT POLICIES CONCERNING YOUR MEMBERSHIP

1. Release and Waiver of Liability

I, for myself, my heirs, executors and assigns, have read and understand this waiver and have been fully
informed of and acknowledge, assume and accept the risks inherent in the use of the Club services and facilities.
I voluntarily assume the risk of injury, accident, death, loss, cost or damage to my person or property which
might arise from my use of the Club and I release the Club from any and all claims and liabilities resulting from
the ordinary negligence of the Club and its owners, officers, employees or agents. I certify that I am in good
physical health and am able to undertake and engage in the range of physical activities in which I choose to
participate. I assume all responsibility for updating the Club of changes in physical and mental condition and
for reporting all injuries sustained at the Club to the manager on duty at the time. *(Please note that a parent
or guardian must sign at the bottom of this form if the member is under 18 years of age)

2. Use of Center Facilities

My membership plan type determines which facilities I am entitled to use at the Club. Club management may
from time to time change the rules governing the operations of the Club, schedules of activities and hours open.
Members shall be provided with notice of these changes. Unauthorized use of facilities may result in
membership suspension or cancellation. Club management may suspend or cancel the rights, privileges or
memberships of any Member whose actions are detrimental to the enjoyment of the Club facilities by other
Members, or for failure to comply with Club rules.

4. Membership Changes and Transfers: Administrative Fees

An administrative fee of $50.00 shall be charged for membership plan changes, transferring your membership
to a non-member (only certain memberships are transferable), and other administrative transactions determined
by management. If a member elects to change or transfer a membership agreement, it is not considered a new
membership agreement, the liability waiver will apply, and the first paragraph of Buyers Right to Cancel will
not apply. If your membership includes transferability, you are allowed to give or sell your membership to a
non-member subject to (a) completing the necessary paperwork, (b) payment of the $50.00 administrative fee,
and (c) acceptance by management of the applicant.

PLEASE NOTE THAT ONLY MEMBERS OVER THE AGE OF 16 YEARS MAY USE THE FACILITY
WITHOUT PARENTAL SUPERVISION.

*Signature of Parent or Guardian

Member Signature

Date

Date

Waiver and Release

I do hereby agree to participate in the Shieijyuku Karate Academy (New International Karate LLC) located
at 7042-B Market Street Wilmington NC 28411. The responsible party must read the entire contract
before signing.
I recognize the risks of injury that are common to any performing arts program that my child or I
participate in and I do hereby waive and release the New International Karate Shieijyuku LLC from and
against any and all claims, actions, causes of action, damages, costs, liabilities, expense of judgments,
including attorney's fees and court costs, that arise out of my participation in this program. I hereby
execute this Waiver and Release form permitting my minor child and / or myself to participate in the New
International Karate Shieijyuku LLC program.
I understand that the classes are based on a twelve month calendar year and that tuition for the (years)
school session is based on a twelve month calendar year. Students will average eight or more classes
per month / per calendar year. I understand that three installments for new enrollments are due at
registration: annual registration, first month and last month tuition. Last month tuition is a one-time fee as
long as the student remains in the program. Students renewing will pay their annual registration fee on or
before May 1st of each year. Tuition and testing fees (if eligible) are due and must be paid on or before
the 25th of each month, regardless of Student's absence, major holidays, and / or school holidays. I
understand that I will not receive a courtesy bill reminder, and that tuition not received by the first of each
month.

I have executed this Waiver and Release this ______ day of _______, 20______.

___________________________________________________
Signature of Student or Parent / Guardian if under the age of 21

___________________________________________________
Signature of Company representative