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TOUGH BARBELL CLUB LLC

CREDIT CARD / ACH PAYMENT AUTHORIZATION FORM

6088 Nashville Highway, Chapel Hill, TN 37034

This form authorizes Tough Barbell Club LLC to charge your credit/debit card or bank account for services rendered, including gym membership(s), training, and add-on services. This authorization will remain in effect unless and until you provide written notice of cancellation as outlined below.

MEMBER INFORMATION

• Primary Account Holder Name: {PrimaryName}

• Phone Number: {PhoneNumber}

• Email Address: {EmailAddress}

BILLING INFORMATION

• Billing Address: {Billing_Street_Address}

• City: {City}

• State: {State}

• Zip Code: {Zip_Code}

PAYMENT METHOD

Select one:
[ ] Credit/Debit Card
 - Name on Card: {NameOnCard}
 - Card Type (Visa / MasterCard / AMEX / Discover): {CardType}
 - Last 4 Digits of Card: {CardLast4Digits}
 - Expiration Date (MM/YY): {ExpirationDate}
 - CVV Code: {CVVCode}

[ ] ACH Bank Draft
 - Account Holder Name: {BankAccountName}
 - Routing Number: {RoutingNumber}
 - Account Number: {AccountNumber}
 - Account Type (Checking or Savings): {AccountType}

PAYMENT AUTHORIZATION

Select one:
[ ] One-Time Charge of: ${One_Time_Amount}
[ ] Recurring Charge of: ${Recurring_Amount}

This amount covers the following membership(s) and/or services:
{Membership_Description}
(e.g., “2 gym memberships and 1 online coaching program”)

• Payment Frequency: {Custom_Frequency}

• First Charge Date: {StartDate}

• End or Cancellation Date (if applicable): {End_Date_Or_Cancel_Info}

TERMS & CONDITIONS

By signing below, I agree to the following:

• I authorize Tough Barbell Club LLC to charge my payment method for the agreed-upon services.

• I understand this authorization will remain active until I provide 15 days’ written notice to cancel.

• I understand no refunds will be issued once payment is processed unless agreed to in writing.

• Failed payments may result in a $25 fee and suspended gym access.

• If my payment covers multiple memberships, I accept full responsibility for the total amount.

• I agree to resolve payment disputes directly with Tough Barbell Club LLC before disputing with my bank or card issuer.

• This form will be securely stored in AURIC, our CRM platform, for compliance and security.

• I consent to electronic signature under the E-SIGN Act.

CONFIRMATION

• Authorized Total to Be Charged or Drafted: ${AuthorizedTotalAmount}

• Optional Notes or Special Billing Instructions: {Billing_Notes}

TOUGH BARBELL CLUB
WAIVER, RELEASE, AND TERMS OF USE AGREEMENT

Effective for all active members during membership term

1. ASSUMPTION OF RISK AND RELEASE OF LIABILITY
By signing this agreement, I acknowledge that I am voluntarily participating in activities at Tough Barbell Club located at 6088 Nashville Hwy, Chapel Hill, TN 37034. These activities include but are not limited to: weightlifting, resistance training, conditioning, functional fitness, group sessions, open gym access, and the use of all gym equipment and facilities. I fully understand the risks involved in such activities, including serious injury or death, and assume all responsibility for those risks, whether known or unknown.

I hereby release and hold harmless Tough Barbell Club, its owners (including Tyler Obringer and Katie Breeding), staff, trainers, agents, and affiliated persons from any and all liability for injuries, illness, accidents, damages, or losses that may occur while on gym premises or participating in any gym-related activity.

2. 24/7 ACCESS AGREEMENT
I acknowledge that Tough Barbell Club may operate unstaffed during certain hours, and I accept full responsibility for my own safety during those times. I will not allow unauthorized persons into the facility. I understand that any violation of this policy may result in immediate termination of my membership without refund.

I agree that misuse of 24/7 access (e.g., sneaking in non-members, failure to secure doors, or using access for unsanctioned purposes) may result in personal liability for damages and loss of membership.

3. CODE OF CONDUCT & GYM RULES
Members agree to the following:

• Clean up after yourself. Wipe down equipment. Don’t leave weights out.

• Respect equipment. If you break it from negligence, you may be asked to replace it.

• Return everything to where it belongs.

• No bullying, harassment, or intimidation—toward members, staff, or guests.

• Do not steal, disrespect the space, or bring in outside drama.

• This is a community gym built on trust. Violating that trust can and will result in revoked access.

4. MEDIA RELEASE
I grant Tough Barbell Club the right to use photos or video of me taken on premises for promotional purposes, including social media, unless I specifically request in writing not to be included.

5. ZERO TOLERANCE POLICY ON HARASSMENT/BULLYING
Tough Barbell Club maintains a zero-tolerance policy for sexual harassment, bullying, or aggressive conduct. Any reports of such behavior will be investigated, and confirmed incidents will result in immediate termination of membership and possible legal action.

6. MEDICAL TREATMENT & EMERGENCIES
In the case of an emergency, I understand that Tough Barbell Club staff may provide basic first aid only (e.g., wound cleaning and bandaging). I accept full responsibility for any medical treatment required beyond that and agree that it is my responsibility to carry my own health insurance and seek proper medical care when needed. I understand there is no AED device on site and that staff are not required to provide advanced medical care.

7. LEGAL ACKNOWLEDGMENT
I affirm that I am 18 years or older. I have read, understood, and voluntarily agree to the terms laid out in this waiver. I understand that every minor member must have an adult membership tied to their account for liability and supervision purposes. This release shall be governed by Tennessee law and shall remain in effect for the duration of my membership. If any portion is deemed unenforceable, the rest shall remain in full force.

8. CREDIT CARD AUTHORIZATION
I authorize Tough Barbell Club to charge the credit card listed below for membership fees, add-ons, or any agreed-upon services. I understand that this authorization will remain in effect until I cancel in writing and all outstanding balances are paid in full. I agree to keep a valid card on file for the duration of my membership.

Total to be charged (per account not house hold) : $

Cardholder Name:
Billing Address:
City, State, Zip:
Card Type (Visa/MC/AMEX):
Last 4 Digits of Card #:
Expiration Date:
CVV (3-digit code):
Signature for Authorization:
Date: {sign_date}

Emergency Contact:
Name: {contact_name}
Phone: {contact_phone}
Relationship: {contact_relation}

Member Acknowledgment
Name: {name}
Date of Birth: {dob}
Address: {address}
Phone: {phone}

Parent/Guardian Consent (if under 18)
I am the legal guardian of the participant named above and consent to the terms of this agreement.

Parent/Guardian Name: 

Parent/Guardian Drivers License:
Relationship to Minor: