HomeMy WebLinkAboutTanning Info Cards NAME
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' World Gym Yarmouth
Guest Registration �
! 17 Long Pond Drive, South Yarmouth, MA 02664
Name �
Street Address
CitY State_Zip
Phone - - Date / /
How did you hear about our gym?
Referral_,Yellow Pages_, Internet_, Other
Tour_ Day Visit
LIABILITY WAIVER PLEASE READ AND SIGN BELOW I
Guest hereby stipulates that he/she is physically sound and that he/she has medical
approval to proceed with a routine of exercise. LIMITATIONS OF EXERCISE , IF
, ANY: It is further expressly agreed that all weightlifting, bodybuilding,dancing or any
� other exercise and�anning,shall be undertaken by me at my sole risk and that WGY
Inc. D/B/A World Gym South Yarmouth, it's servants, agents or employees shall not
liable to me for claims, demands, injuries, damages, actions or causes of action,
whatsoever,to my person or property arising out of or connected with the use by
me of the services or facilities of WGY Inc. D/B/A World Gym South Yarmouth on�he
premises where�he same is located,and I do hereby expressly forever release and
� discharge the WGY Inc. D/B/A World Gym South Yarmouth from all such claims, '�
� demands, injuries,damages,actions or causes of action,and from all acts of active �'�.
or passive negligence on the part of WGY Inc. D/8/A Wodd Gym South Yarmouth, iPs i
servants,agents or employees. I further expressly agree that I will not use weights,
equipment,or machines improperly. IF I HAVE ANY QUESTIONS WHATSOEVER, �
CONCERNING USE OF SAID EQUIPMENT, I AGREE THAT I WILL RE�UEST �-
INSTRUCTION FROM EMPLOYEES OF WGY INC. D/B/A WORLD GYM SOUTH ��
YARMOUTH. DO NOT SIGN THIS AGREEMENT UNLESS YOD UNDERSTAND �'
THE TERMS COMPLETELY. IF YOU DO NOT UNDERSTAND,YOU SHOULD SEEK �
� LEGAL COUNSEL. �
�
Guest Signature X i
JHN-01-2005 09 :36 PM JOE. RIZ20 19784438983 P. 01
Worid 6ym tanning schedule d� liability waiver Date "/�
BY mY'�9n�+A www,n a o�neNy wrow thn nnninp�naq w und�eaken by ms at my u��c and thae wav ma.aea wond c3y�o rarmouth,
M's owrwn�atockholden uW ampbysss shall not W N�ws Eo ms for daN»,arnuq��InJwN��Com�pes.ecflon�or m�ss of ectlon.wn�fewvx�b my
Pe�^a DroP�Y a'sin0 out ol ot oonneded wMh MB We bY me W Ma ssrvioes w or fadltMs MWCsY Inc.tlba Werld Gym Yrmoufh,demands.
and I do Mroby 9�re•r�ly for�var roWaE entl dpeharys WpV Inc,�a Wodd Gym VafRWulA fiom all 6uph daima.injuries,damapes,adiona or
CBUBE!Cf ecNm,end lrp�f�g�M adAro or pa9sive nepllgmce on tl�e part u}yyGY Ina tlba World Gym VarmouC�,iPa ovmorG,stodc twWars
Ylld YfllpbyNL .
Tlms 5�9�t� Dw�aHon TiTe Si9��'e Ot11'ation
5:30 AM 1:15 PM
5�45 AM 1:30 PM
6:00 AM 1:45 PM
6:15 AM p;pp pM
6:90 AM 2:15 PM
6:45 AM 2;30 pM
7:00 AM 2:45 PM
7:15 AM 3:00 PM
7:30 AM 3:16 PM
' �=�� 3:30 PM
8:00 AM 3:45 PM
8:15�M a:op PM
8:30 AM 4:15 PM
8:4 AM 4:30 PM
9���M 4:45 PM
9:1'3 AM 5:00 PM
9:30 AM S:ID PM
9:45 AM 5:80 PM
10°�� 5:45 PM
30:15 AM 6:00 PM
30:30 AM 6�15 PM
10:46 AIU 6:30 PM
i1:00 AM 6�45 PM
11�15 AM 7:00 PM
11:30 AM 7:15 PM
11:46 AM 7:30 PM
12:0p PM 7: PM
12:15 FM 5:00 PM
12:30 PM 8:15 PM
12:45 PM 8:30 PM
i:OO PM 8:45 PM
r
Tanning Cliertt Card
,
;
NAME i
�
ADORESS
CITY STATE ZIp
�. HOMEPHONE WORKPHONE
�. REPERRED BV: �
PLEASE ANSWER THE FOLLOWING TO THE BEST OF YOUR KNOWLEDGE:
� 1. Do yau normalry tan in nalurel aunlighYl Ves_ No_
� 2. Are you tan noWl Yes No_
3. Wilh what Eegree do you tan in natural suMight?(check one)
, Tan easlty_ qverage_ Tan wil�diHkulry_
� 4. Witn wnat degree do you burn in naNral sunlpht?(c�eck one)
� Do not Curn 6cperiance some Eurning Bum easily
5. Heve you ever IanneA under ultraviolet IigM belo�e7 Yes No
II ye's,an0 any complicalions were incurred,please describe!
�� 6. HaveyoueverhadanegaNvereactiontosunlightl(sunpoisoning,rash,etc.�Yee No
II yes,please descr10e1
. 7. Areyoup�esentlylakinga0�escriptionoldrugsormedicationthatmaywusesensitivitytot�esun?
� II Oueslionable.see listing irom receplionist.Ves_ No_
.. Q agree to check listing il 1 Degm taking any new tlrugs or meCication.)
B. MaveyoueverDeenadviseObyap�ysiciantoresirictexposurelosualighY/Yes_No_
II yes,pleaze descnbe!
9. Are you utilizi�g our facilities lor healt�reasonsT Yes No
. It ye;pleasa descnDe!
. 10. I/'female,ara yoapregnant7 Yes No_� . �
. pf I do become pregnant,I agree to bbtain a doctofs release to contlnue tanning.) i
� 11. Do yovwea�contacfsT�(If yes,please rempve before"Tannirg".)Yea No_
12. How did you hear of our tanning facililyT
I have had the above questions explained[o me and have answered the above to Ihe best of my
knowiedge. I have read and understand ihe instructlons br ihe proper use oi ihe tanning ��
equipment and lacilities. I untlerstand that the tanning beds may cause dryness or other i
� disorders to the skin as could be caused by natural sunlight.I do hereby agree to indemnify antl
save harmless[he owners,operetors,an0 other employees of this tanning facility of and irom any
and all lia6ility arising ou[al my use of such equipment and facilities.
� Signeture �ata
Sipnature Date I
I��nl�l eqrulw�rpuiraJ i1 cYwil lt wM��1B y��n q pq
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�'J THE BODV FIRM, ING. t•9tltld4Y-Ba00 IN MA�50�699-2227