BlackEye Athletics Enrollement Form

Training Chosen *

Boxing - $99

Cardio Kickboxing - $99

Kids 4y-8y BJJ - $135

Personal Training - $100 Per Hour

Muay Thai - $135

Adult BJJ - $135

Youth 8y & Up BJJ - $135

**Dates/Times for personal training subject to availability of trainers**

This Membership Agreement is entered into by BlackEye Athletics and the individual student or their legal parent/guardian if the student is under 18 years of age. By signing this agreement, the responsible party acknowledges that they have reviewed, understand, and accepted the Terms & Conditions outlined herein. The student(s) or legal parent/guardian is aware that any modifications, suspensions, or cancellations to their account require a 30-business day advance notice via email to [email protected]. Verbal requests will not be considered valid.

Name (Parent/Guardian if Under 18): *

Date: *

Street Address: *

Postal code *

State *

City *

Phone *

Email *

Emergency Contact Name: *

Emergency Contact Phone: *

Preferred method of contact? *

How did you hear about us? *

What are your fitness goals? *

Do you have prior Martial Arts Experience? *

Yes

Do you have any friends or family that may be interested in getting in shape? *

Yes

Payments are due on the renewal date & will be prorated accordingly. Late payments may incur a $35 late penalty fee.

Recurring Payment Information: *

1st

15th

*Boxing Payments 1st of Month Only

Email Address (for payment receipt): *

STUDENT INFORMATION
Clearly print the name and birth date of each individual student attending class.

A Liability Waiver/Health Release Form must be completed for each person participating in the program.

Name: *

Date of Birth: *

Name:

Date of Birth:

Name:

Date of Birth:

Are there any current or previous injuries/illnesses for any of the students listed above that the trainer should know? *

MEMBERSHIP TERMS & CONDITIONS

MEMBERSHIP PERIOD: The membership period is one-month and will automatically renew each month unless canceled 30 days prior. Fees subject to change by BlackEye Athletics.

Cancellation Policy: Notify us via email at least 30 days before your next payment date or 2 weeks before a suspension request. Send request to [email protected] Confirmation email required for all requests."

SUSPENSION POLICY: After 6 paid months of service, members are permitted one suspension per year with a $25 reinstatement fee. Requests must be submitted via email to [email protected] at least 2 weeks before the suspension date. A reply acknowledging the request is required.

PAYMENTS: To maintain an active membership, ensure there is always a valid credit card on file for monthly payments. If a payment fails, a $35 processing fee will be charged after the second attempt. After three failed attempts, BlackEye Athletics reserves the right to cancel your membership once your account is up to date. Keep your payment information current to avoid any disruptions to your membership status. Notify BlackEye Athletics [email protected] of any payment method changes at least 15 days before the next billing cycle to avoid a $35 late fee penalty.

PRORATED PAYMENTS: The first month's payment will be prorated based on your enrollment date. Subsequent payments are due on the first or fifteenth day of the month (1st of the month for Boxing). By making payments for subsequent periods, you agree to continue your membership under the terms of this agreement. Membership fees are non-refundable.

RATE CHANGES: Membership rates may change. Changes will be posted on the BlackEye Athletics website(s) at least 45 days before taking effect on the member's renewal date (next payment period) following the notification.

BUYER'S RIGHT TO CANCEL: You can cancel this agreement by emailing [email protected] within 7 business days of your first class. The email must state your desire to cancel the membership. If loaner gear was provided, return it to avoid being charged for the equipment. This agreement may also be cancelled if BlackEye Athletics ceases operation.

CLASS SCHEDULE: The schedule will be available at the gym and BlackEyeAthletics.com. BlackEye Athletics may adjust the schedule temporarily or permanently at any time for any reason.

ADDITIONAL COSTS: Uniforms, equipment, camps, private lessons, tournaments etc., are not included in tuition or registration fees. A uniform (GI) is required for BJJ class, while kickboxing requires hand wraps and boxing gloves. Gear can be purchased from BlackEye Athletics or other suppliers. For gear requirements, consult your instructor.

CHILDREN WHO ARE NOT ATTENDING CLASS, MAY NOT BE LEFT UNATTENDED TO PLAY INSIDE/OUTSIDE THE GYM FOR HEALTH AND SAFETY REASONS.

MEMBERSHIP AGREEMENT ACKNOWLEDGMENT: By choosing a martial art training program and signing this document, I confirm that I have reviewed and understood the terms of this Membership Agreement and have signed a Liability Waiver/Health Release Form. I agree that my likeness and images may be used for promotional or marketing purposes. In the event of any changes to the terms and conditions, a new agreement will be required.

PRINTED NAME: *

Printed Date: *

SIGNATURE: *

Clear

(Parent/Guardian if under 18)

Training Chosen *

Boxing - $99

Cardio Kickboxing - $99

Kids 4y-8y BJJ - $135

Personal Training - $100 Per Hour

Muay Thai - $135

Adult BJJ - $135

Youth 8y & Up BJJ - $135

**Dates/Times for personal training subject to availability of trainers**

Name (Parent/Guardian if Under 18): *

Date: *

Street Address: *

Postal code *

State *

City *

Phone *

Email *

Emergency Contact Name: *

Emergency Contact Phone: *

Preferred method of contact? *

How did you hear about us? *

What are your fitness goals? *

Do you have prior Martial Arts Experience? *

Yes

Do you have any friends or family that may be interested in getting in shape? *

Yes

Payments are due on the renewal date & will be prorated accordingly. Late payments may incur a $35 late penalty fee.

RECURRING PAYMENT INFORMATION: *

1st

15th

*Boxing Payments 1 st of Month Only

Email Address (for payment receipt): *

STUDENT INFORMATION
Clearly print the name and birth date of each individual student attending class.

A Liability Waiver/Health Release Form must be completed for each person participating in the program.

Name: *

Date of Birth: *

Name:

Date of Birth:

Name:

Date of Birth:

Are there any current or previous injuries/illnesses for any of the students listed above that the trainer should know? *

MEMBERSHIP TERMS & CONDITIONS

MEMBERSHIP PERIOD: The membership period is one-month and will automatically renew each month unless canceled 30 days prior. Fees subject to change by BlackEye Athletics.

CLASS SCHEDULE: The schedule will be available at the gym and BlackEyeAthletics.com. BlackEye Athletics may adjust the schedule temporarily or permanently at any time for any reason.

CHILDREN WHO ARE NOT ATTENDING CLASS, MAY NOT BE LEFT UNATTENDED TO PLAY INSIDE/OUTSIDE THE GYM FOR HEALTH AND SAFETY REASONS.

PRINTED NAME: *

Printed Date: *

SIGNATURE: *

Clear

(Parent/Guardian if under 18)

BlackEye Athletics

214 Edge Rd. Villa Rica GA. 30180

678-457-2507V4. 6.2024

BlackEye Athletics

214 Edge Rd. Villa Rica GA. 30180

678-457-2507V4. 6.2024