Team Robinson MMA

Enrollment Agreement # ___________________

The undersigned agrees to take and this gym agrees to teach a course of mixed mart ial arts lessons consisting of a
maximu m o f _________ classes per week.
Starting date: ________________ End date: after a cancellation agreement has been signed by the undersigned.

Cred it Card: Circle one Name on Card: CC# Exp . Date

Visa MC
Debit Disc

The undersigned agrees to pay total payments shown above in monthly installment s of $ ______ with the first
installment of $ __________ payable on _____________ and all subsequent installments on the same day of each
consecutive month until paid in full o r a cancellation agreement has been signed.
Member’s Name: Date of Birth:
Member’s Address: Ho me Phone:
Work Phone:
Cell Phone:
Email:
Terms
*The down payment made upon enrolling at Team Robinson MMA goes toward the first month of training and is non -
refundable along with any other fees or tuitions paid to Team Robinson MMA. There will be a $30.00 charge for any late
tuition payment. There will be a $50.00 fee for any chargeback not authorized by Team Robinson MMA.

I understand and agree the Team Robinson MMA or its agents or emp loyees will not be held liable for injuries,
damages, etc., not caused by or resulting fro m the negligence of the owners, operators, employees, or persons in
charge of such establishment. I agree to abide by the rules and regulations governing the conduct and operation of
instructions sessions, students, and observers, in order to pro mote efficiently, safety, and recognition of the
instruction certification, as prescribed by Team Robinson MMA. I acknowledge that rules and regulations governing
Team Robinson MMA may change from time to time and I agree to abide by all such rules and regulations as
adopted or hereinafter amended. I agree that the hours of operation and schedule of classes may be changed at the
discretion of Team Robinson MMA and in no way gives cause or permission for termination of this agreement.
Team Robinson MMA reserves the right to revoke or terminate any membership. I will faithfully co mply with all
the rules and regulations of Team Robinson MMA. I understand that Team Robinson MMA reserves the right to
change students classes based on age, height, weight, size, rank, or any other criteria it see fit. I further understand
that failure to co mp lete the training does not relieve me of my financial obligation to pay the tuition in full. The
payer agrees unconditionally to pay the above tuition without regard to the attendance made or classes missed.
Missed classes may be made up but not redeemed for cash. Make-up classes are only available for act ively enrolled
students. *In consideration of the training obligated, I the enrollee agree that I will not during the continuance of this
agreement and for a period of three (3) years fo llo wing termination of my association with the gym engage in
teaching Bo xing or any form o f Mart ial A rts or offering similar training or instruction within a t wenty -five (25) mile
radius of any gym operated by Team Robinson MMA without the express written authorization of the same. I agree
that cancellations must be requested not less than seven (7) days prior to payment due date. The persons owning
Team Robinson MMA and the agents and employees shall not be responsible for damages, lost, or stolen articles
inside or outside the facility. I understand that Team Robinson MMA is no responsible for unattended children.

__________________________________________________ _______________________
Member/Parent Signature Date
 Team Robinson MMA

$50.00 – Registration fee for MMA Training

$50.00 – Registration fee for Personal Training

Client Information

Please print clearly

Last name___________________________________ First name______________________________

Address_________________________________________ City________________ ____________

State ______________ Zip code _______________

Telephone: Home _______________________________ Cell _________________________________

Email address: ________________________________________________________________

Emergency contact:
Name: _____________________ Relationship: _______________ Telephone number: __________________

Fitness Information
Current physical fitness level: ________________________
(Poor, fair, good, excellent)

Do you have any physical limitations? If so, please list.

_________________________________________________________________________________________________
Please list any medical problems.
_________________________________________________________________________________________________
What are your goals?
_________________________________________________________________________________________________

Areas of concern: ___________________________________________________________

Training Program(s) of interest: ____________________________________________

Signature _______________________________________________ Date __________________________

 Team Robinson MMA

I, ____________________________________, as a member, guest, parent, or spouse as applicable

agree that any physical exercise or activity that I participate in on the gym premises, I do so at my own
risk. This includes, without limitations to my use of equipment, restrooms, parking areas, sidewalk,
weight room, and training areas, and my participation in any activity, call program or instruction now or
in the future made available. I agree that I am voluntarily participating in these activities and using the
equipment and facilities and assuming all risk of injury or my contraction of any illness or medical
condition(s) that might result. Also, any damage, loss or theft of any personal property while on premises.
I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents,
and assigns) to release Team Robinson MMA, its employees, agents, or any affiliates of the gym from any
and all claims or causes of action arising out of Team Robinson MMA negligence. This WAIVER and
RELEASE Form releases Team Robinson MMA of all liabilities which includes, but without limitations to
injuries which may result from improper maintenance of any exercise equipment that may malfunction or
break under Team Robinson MMA’s instruction or supervision and my slipping and falling while in any
area on the premises noted above.

I understand and agree to the above Waiver and Release terms.

______________________________________________ __________________
Name of Client (Please print) Date

_______________________________________________ _________________
Signature of Client/Parent or Guardian (if minor) Date