INFORMED CONSENT & PRIVACY ACT FORM:

I, the client/participant, give my consent to participate in the physical fitness evaluation program conducted by KC180Fitness LLC.

BENEFITS
Participation in a regular program of physical activity has been shown to produce positive changes in a number of organ systems. These changes include increased work capacity, improved cardiovascular efficiency, and increased muscular strength, flexibility, power and endurance.

RISKS
I recognize that exercise carries some risk to the musculoskeletal system (sprains, strains, breaks) and the cardiorespiratory system (dizziness, discomfort in breathing, heart attack). I hereby certify that I know of no medical problem (except those noted below) that would increase my risk of illness and injury, even death, as a result of participation in a regular exercise program.

TESTING AND EVALUATION RESULTS
I understand that I will undergo initial testing to determine my current physical fitness status. The testing will consist of completing this health inventory and being tested for muscular fitness and body composition. I further understand that such screening is intended to provide KC180Fitness LLC with essential information used in the development of individual fitness programs. I understand that my individual results will be made available only to me. I also understand that testing is not intended to replace any other medical tests or the services of my physician. I will be provided a copy of all test results. I may share the results with whomever I please, including my personal physician. By signing the consent form I understand that I am personally responsible for my actions during my tenure at KC180Fitness LLC, and that I waive the responsibility of this center if I should incur any injury as a result of my negligence.

OUR COMMITMENT TO YOUR PRIVACY
In conducting our business, we will create records regarding you and the services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your individually identifiable health information (IIHI). By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. Our practice will obtain your written and/or electronic authorization for uses and disclosures that are not permitted by applicable law.

WAIVER OF LIABILITY

As a participant in this program, you represent that you have no congenital physical or mental health problems that will preclude participation in the services provided by KC180Fitness LLC specifically, you represent that you have no underlying cardiovascular, neurological, orthopedic or any other illness that will preclude participation in any training program. You assume risk with any/all of the fitness programs specified under this agreement provided by KC180Fitness LLC.

You also acknowledge that high intensity interval training, boot camps, cardiovascular exercise, martial arts, kick boxing, running, resistance training, timed events, obstacle courses, and any other related sports activities are an extreme test of one's mental and physical limits and carry with it potential for damage or loss of property, serious injury and death. You also understand the risks of participating in these types of events/activities, you are healthy enough to participate, and you have a regular medical physician that you can contact regarding any medical problems that you might develop. You expressly waive, release, discharge and agree not to sue (from any liability of death, disability, personal injury, or action of any kind) KC180Fitness LLC, Kri Chay, his assistants/instructors or any other guest or person acting on behalf of KC180Fitness LLC.

NON-COMPETE/ NON DIS-CLOSURE
As a member of KC180Fitness LLC dba Kri Chay's Urban HIIT FITT, you will be receiving privileged information intended for YOUR education, YOUR physical improvements and YOUR mental focus only. The KC180Fitness LLC program may NOT be reproduced, stored in a retrieval system, or transmitted, in any form or by means electronic, mechanical, photocopying, and recording. You also testify that you do not work in a competitive or similar fitness/ health field and have no immediate intentions or later intentions of developing a similar type of fitness program. Should you decide to disclose/use this information, you agree that you will be held liable for attorney fees.

MISSED DAYS/ ABSENSES
You may make up any missed days during your current course or the week after. Any unused days past the fitness classes limit will be forfeited. You may NOT transfer your missed days to family members/friends, etc. You may not pro-rate any monthly fees because of missed days. Payments are due in full no matter how many days you miss or are able to make up.

PHOTO AND/OR VIDEO RELEASE/QUOTES
Action photos or videos may be taken throughout the program for purposes of promoting KC180Fitness LLC. These photos/videos may be printed in newspapers, magazines, websites, commercials and other forms of advertising. You agree that these photos/videos are the property of KC180Fitness LLC and may be used at any time for promotional purposes. We will ask for your permission first before printing any individual "before and after photos/videos." You also agree that any quotes given in surveys will be used for promotional purposes only.

TRANSFERS/ CHANGES
Once enlisted into a course, you must complete that entire agreement/course before switching to a different course length. (i.e. You must start and/or complete one full training session phase (4-6 weeks) at the introductory rate before signing up/receiving the longer termed rates of six weeks and more. You may transfer your fitness sessions of any length to another person, friend or associate, once it is approved by a member of KC180Fitness LLC. There is a $25 transfer fee to do so. It is the members/clients responsibility to find another member to take over their contract. Once KC180Fitness LLC member and the client are in agreement, the client who is transferring their membership will write a check or cash of $25 to KC180Fitness LLC. Once the check/cash has cleared, KC180Fitness LLC will transfer the membership over to the new member/client.

REFUNDS/CANCELLATION
Refunds are only made if not satisfied with KC180Fitness LLC within the first 30 days of a clients first fitness training session, typically their first 4-6 weeks. If you have to cancel this agreement for ANY reason (sick, injury, family emergency, work change etc.) and are only signed up for one training session - you will still owe any remaining balance by the last day of your first training session, typically your first 4-6 weeks. You may make up any missed days during the current training session or following training session. After that time, your unused days will be automatically forfeited.
If you pay by check, you will still be responsible to either mail or hand-deliver any remaining balance to the main member of KC180Fitness LLC, Kri Chay. If you have paid a deposit and are not able to start on the date requested, you may apply that deposit to another fitness training session and have up to two training sessions to use that deposit. If unable to attend within that new time frame, you forfeit your deposit. If you wish to cancel/suspend/stop/quit training with KC180Fitness LLC after the initial first 30 day period from the first training class, you can do so by paying a termination fee of $260 by cash or check paid to KC180Fitness LLC, after submitting a handwritten letter to the member Kri Chay or speaking with him in person with the intent to cancel classes.

WINNING RULES
If you have won a training session(s) via an auction or raffle or other prize, you must present your winning certificate number and the hard copy upon registration to avoid any additional fees. No matter how you have won your training session(s), there are no transfers or refunds.

PAYING BY CREDIT CARD
I understand that my credit card statement will read: SEXY BACK BOOTCAMPS or KC 180 FITNESS LLC. If for some reason my credit/debit card transaction fails to go through, I will give a new credit/debit card number as soon as I am notified to avoid any late charges. All credit card payments are to made online through the payment website Volo Innovations. There will be a link on the website http://www.kc180fitness.com through the "MEMBERS ACCOUNT" tab, or the website name given to me upon request. If for some reason a credit card payment fails to process and payment is termed late after the due date, KC180Fitness LLC has the right to terminate my training membership at any time.

PAYING BY CHECK
I understand that if I pay by check, I understand I am waiving my right to pay by credit card which has the benefits of easy tracking, no late fees. I will ensure that my check is hand delivered or mailed to the address of KC180Fitness LLC ON or BEFORE each payment is due. If for some reason KC180Fitness LLC does not receive my check ON or BEFORE the date a payment is due, KC180Fitness LLC has the right to terminate my training membership at any time.

LEGAL REMEDIES
I also understand that if KC180Fitness LLC needs to enforce the payment terms of this agreement by and through any legal remedies available; that besides the amount that I owe to KC180Fitness LLC, I will be responsible for any and all legal fees incurred by KC180Fitness LLC to enforce my financial obligations that I have agreed to. KC180Fitness LLC reserves the right to refuse service to anyone if they are not at a level of fitness appropriate to participate in the majority of activities and exercises. The same holds true if someone works for, is employed, or plans to work in a competitive field with KC180Fitness LLC.

By training/participating with any of KC180Fitness LLC's Coaches/Trainers at our facilities or during training sessions conducted and lead by a KC180Fitness LLC Coach/Trainer on location or off location, whether it is a free trial session or sessions, or by purchasing or participating in any programs such as one on one training, group training, purchasing fitness products, merchandise, and any other items from KC180 FITNESS LLC via cash, check, or debit/credit card through the online merchant companies we currently use including but not limited to: Paypal, Stripe, Paypal Here, Volo Innovations, Square... I acknowledge that I have read and agree to the Informed Consent and Privacy Act Forms, and Waiver of Liability statement.