ACTIVITY REGISTRATION FORM

HOW TO REGISTER

Club – Bring your completed forms to the Front desk, Activity Center desk or drop-slot.
Fax – Fax your completed forms to your club using the contact information in the Activity Guide. The Activity Center staff will contact you to confirm
receipt within 24 hours.

PARTICIPANT INFORMATION
Participant 1 Participant 2

_________________________________________________________________________ _________________________________________________________________________
First Name Last Name Date of Birth Gender First Name Last Name Date of Birth Gender

_______________________________________________________________________________________________________________________________________________________
Day Phone Evening Phone Email

_______________________________________________________________________________________________________________________________________________________
Address City State Zip

If Participant(s) is under 18 years of age, complete the following:

_______________________________________________________________________________________________________________________________________________________
Parent Name

_______________________________________________________________________________________________________________________________________________________
Emergency Contact 1 Name Phone Emergency Contact 2 Name Phone

PARTICIPANT ACTIVITIES
List the club location for programs here: ______________________________________________________

Participant 1 Participant 2

Swimming (All Ages)

Please indicate your top two class choices. We will do our best to accommodate your first choice, which will be communicated on the posting date
referenced in the Activity Guide. On this date, participants’ class assignments will be posted in the Indoor Pool area.

First Class Choice First Class Choice

_________________________________________________________________________ _________________________________________________________________________
Class Day(s) Time Registration Code Class Day(s) Time Registration Code

Second Class Choice Second Class Choice

_________________________________________________________________________ _________________________________________________________________________
Class Day(s) Time Registration Code Class Day(s) Time Registration Code

Activities (Sports & Activities, All Ages) Activities (Sports & Activities, All Ages)

_________________________________________________________________________ _________________________________________________________________________
Activity/Class Session Level Registration Code Activity/Class Session Level Registration Code

_________________________________________________________________________ _________________________________________________________________________
Activity/Class Session Level Registration Code Activity/Class Session Level Registration Code

Tennis (All Ages) Tennis (All Ages)

_________________________________________________________________________ _________________________________________________________________________
Class Day(s) Time Registration Code Class Day(s) Time Registration Code

_________________________________________________________________________ _________________________________________________________________________
Class Day(s) Time Registration Code Class Day(s) Time Registration Code

PAYMENT
In consideration for participating in the session class(es), I agree to pay and specifically authorize _________________________________________________________________________
Life Time Fitness, Inc., its subsidiaries and affiliates or its agents on its behalf to automatically and Member Number (required) Cardholder Name
without notice charge the non-refundable amounts described above plus any applicable taxes
according to the payment frequency that I have selected above. If the amount set forth in my
selection above is to be collected by ClubTab, I certify that I am authorized to utilize the ClubTab Cash Check Clubtab* Credit Card
payment method as part of my Life Time Fitness membership. I will be assessed a late fee if I fail
to pay any fees within 10 days of them being due and my participation may be suspended or _________________________________________________________________________
terminated, without notice and at the option of Life Time Fitness, if I fail to pay any fees within Check/Credit Card Number Type Expiration Date
30 days of them being due. I will be responsible for all collection costs, including attorney or other
collection fees. Except as otherwise stated herein, I remain subject to all the terms and conditions
as set forth in my General Terms Agreement and Member Usage Agreement, including but not _________________________________________________________________________
limited to the Assumption of Risk, Release and Indemnity and Waiver of Liability provisions, as well Total Amount (tax may apply – please see number 10 on the following page)
as any other documents relating to the session class(es).

X ____________________________________________________________________
*Signature required. Signature of Cardholder
ACTIVITY REGISTRATION FORM
POLICIES
In addition to the following general policies, individual programs may have
additional policies, which can be found at lifetimefitness.com/activities.
1. Proper membership level for your program location of choice is
required, including junior memberships, for member rates to apply.
Registration is accepted on a space-available basis.
2. Two-week advance registration is recommended for all programs.
We reserve the right to cancel programs with low enrollment.
3. Class fees are non-refundable, except in the following circumstances:
a. For medical disabilities, a prorated refund or credit will be given
when participant provides a doctor’s note stating they cannot
participate in program.
b. If a class is canceled, every effort will be made to find a suitable
class for the participant who has registered for the canceled class.
If a suitable class cannot be found, the participant will be provided
a full refund.
If a refund is granted, the refund will be issued in the same method as
the original payment. Cash payments will be refunded by check.
4. To cancel enrollment in a camp, the Activity Center must receive a
written notice of cancellation two weeks prior to the camp start date.
Upon timely notice, Life Time Fitness will refund amounts paid for the
camp less any camp deposit(s) required under a Payment Plan. Any
payments made beyond the deposit will be refunded with a written two-
week notice. If notice is received less than two weeks prior to the camp
start date, the registrant will forfeit any amounts paid for the camp.
5. T-shirt payment is non-refundable once T-shirt is received by participant.
6. Make-up classes are not given for classes missed by participants.
7. Children must be toilet-trained, except for parent participation classes.
8. We will enforce the Child Center’s policy to exclude sick children.
9. Assume your registration is confirmed and the activity will meet
as scheduled unless you are notified otherwise. For swim lessons,
participants are responsible for checking the swim posting (typically
available by noon on the posting date and located in the pool area
display case) for lesson placement.
10. An Admissions and Amusement tax may apply. Please contact your
club for specific tax details. (The state of Maryland applies tax to
parties, leagues and rentals. The state of Minnesota applies tax to
birthday parties. The state of Missouri applies tax to parties, leagues,
rentals and select programs.)
11. Non-member fees are 25% higher than member fees. Participants
without proper membership level, including junior memberships, will
be charged non-member rates. Life Time Athletic (onyx membership)
locations do not allow non-members to participate in programs.
12. Non-member access includes attending or picking up/dropping off
participants of registered programs. Use of amenities is not included
and requires a daily guest fee and adherence to guest policies.
©2008 LIFE TIME FITNESS, INC. All rights reserved. MACO8100
WAIVER
There is an inherent risk of injury, whether caused by me or someone else, in
the use of or presence at a Life Time Fitness center, the use of Life Time Fitness’
equipment and services, and participation in Life Time Fitness’ programs. This risk
includes, but is not limited to (a) injuries arising from the use of any of Life Time
Fitness’ centers or equipment, including any accidental or “slip and fall” injuries;
(b) injuries arising from participation in supervised or unsupervised activities and
programs within a Life Time Fitness center or outside a Life Time Fitness center,
to the extent sponsored or endorsed by Life Time Fitness; (c) injuries or medical
disorders resulting from exercise at a Life Time Fitness center, including, but not
limited to heart attacks, strokes, heart stress, sprains, broken bones and torn
muscles or ligaments; and (d) injuries resulting from the actions taken or decisions
made regarding medical or survival procedures.
I understand and voluntarily accept this risk. I agree to specifically assume all risk
of injury, whether physical or mental, as well as all risk of loss, theft or damage of
personal property while I am using or present at any Life Time Fitness center, using
any lockers, equipment or services at any Life Time Fitness center or participating
in Life Time Fitness’ programs, whether such programs take place inside or outside
of a Life Time Fitness center. I waive any and all claims or actions that may
arise against LTF Club Operations Company, Inc. (“LTF Operations”), its parent
companies, affiliates, subsidiaries, successors, assigns, independent contractors
and agents as well as each party’s owners, directors, employees or volunteers as
a result of any such injury, loss, theft or damage, including and without limitation,
personal, bodily or mental injury, economic loss or any damage resulting from
the negligence of LTF Operations, its parent companies, affiliates, subsidiaries,
successors, assigns, agents, independent contractors or anyone else using a
Life Time Fitness center. If there is any claim by anyone based on any injury, loss,
theft or damage that involves me, I agree to defend LTF Operations, its parent
companies, affiliates, subsidiaries, successors, assigns, agents and independent
contractors against such laims and pay such parties for all expenses relating to the
claim, and indemnify LTF Operations, its parent companies, affiliates, subsidiaries,
successors, assigns, agents and independent contractors for all obligations
resulting from such claims.
Notice of Registration Posting
I grant Life Time Fitness, Inc., its subsidiaries, agents and representatives
permission to post the names of the Participants on a class assignment list posted
in the indoor pool area at my Life Time Fitness center.
Release of Image and Likeness
I hereby irrevocably consent to and grant Life Time Fitness, Inc., its subsidiaries,
agents and representatives (“Life Time Fitness”) the exclusive and unlimited right to
use and reproduce any and all photographs, audio recordings, video recordings
or testimonial accounts taken by Life Time Fitness that contain my person, name,
image, voice, likeness or account, for any lawful purpose whatsoever and using
any means available, including but not limited to, any Life Time Fitness corporate
or marketing communication or material. I waive the right to inspect, approve
or edit any such use or reproduction, and Life Time Fitness may make any and
all changes, modifications, rearrangements, additions or deletions in its use or
reproductions without any approval.
I have read the above thoroughly and understand the terms. My participation in
the selected activities as well as my agreement to the foregoing are both purely
voluntary and I elect to do so in spite of the risks.
X ____________________________________________________________________
Signature Date
IF PERSON IS UNDER 18 YEARS OF AGE, A PARENT OR LEGAL GUARDIAN
MUST COMPLETE THE FOLLOWING:
I, the undersigned parent or legal guardian of the participant, hereby execute
the foregoing for and on behalf of the participant and agree to bind myself, the
participant and any heirs, next of kin, assigns or personal representatives to such
terms. I represent that I have full legal authority to act for and on behalf of the
participant, and I agree to indemnify and hold harmless LTF for any expenses,
claims or liabilities that may arise as a result of any insufficiency of my full legal
authority to execute the foregoing.
X ____________________________________________________________________
Signature Date