Mattel Fitness Place Membership Form

El Segundo Mattel Fitness Place

Membership Agreement & After Hours Use Liability Waiver
Employee Information
Name
Employee ID*
Date of birth*

MonthDayYear
Date
Email*
example@example.com
Mobile phone #*
Department*
Supervisor*
Employee Information
Emergency contact
Relationship*
Contact's phone #*

Are you presently on an exercise program?*

YesNo
If Yes, please provide details: *
Which Fitness Place Programs are you interested in? (Check all that apply)

Group ClassesPersonal TrainingOther
If Other, please provide details:
List your personal fitness goals in order of priority: *
How many days per week can you devote to your program?*

1-2 days3-4 days5-6 days
How much time per session can you devote to your program?

1. I wish to become a member of the Mattel Fitness Place ("MFP" I do so voluntarily and I acknowledge that becoming a member of MFP is not a condition of my employment by Mattel.
Contract Classification:

Full TimePart Time
Contract START Date:

MonthDayYear
Contract END Date:

MonthDayYear
I am a/an:*

EmployeeInternRetireeEmployee Spouse/Domestic PartnerEmployee DependentContract Employee
2. I understand that physical exercise may lead to injury or other serious medical conditions and acknowledge that I have been advised of the importance of having a thorough medical evaluation prior to commencing an exercise program. I understand that trained medical personnel and specialized medical equipment will not be immediately available in the event of a medical emergency at MFP. I understand that to the extent not covered by my insurance, any medical or other expenses arising out of my participation in MFP programs or activities and use of MFP facilities and equipment are my personal responsibility. In that regard, I also understand that any injuries sustained while participating in MFP activities may not be covered by The Worker's Compensation Act.
3. I understand that MFP staff may wish to conduct certain fitness tests; may request information concerning my own health status (including any changes thereto); and may request that a physician approve (with or without limitations) my participation in physical activities. I certify that any information I provide to MFP about my health and exercise history and current health status is and will be, to the best of my knowledge, complete and accurate, and I agree and understand it is my responsibility to inform MFP staff in the event of any change in my health or medical status. I also understand that by participating in any fitness test and/or providing my health or medical status and exercise history Mattel makes no representations with respect to the condition of my health or whether an exercise program or dietary change are medically appropriate for me. I understand it is my responsibility to consult with my physician regarding these matters. I further understand that any recommendations regarding exercise or diet are entirely my responsibility and that I should consult a physician prior to undergoing any changes in exercise or diet.
4. I recognize and understand that my voluntary participation in physical activities, such as those offered by MFP, carries inherent risk and dangers. I therefore assume all risk of injury, damages, illness, death or other harms, including those caused in whole or in part, by the negligence of MFP, and hereby release, agree not to sue, agree to indemnify, and forever discharge Mattel and its affiliates, subsidiaries, their directors, officers, employees (including but not limited to MFP staff), agents and insurers from any claim and liabilities which I or any of my representatives, heirs, successors and assigns might have arising out of or in any way relating to my receipt of assessment services, participation in MFP activities or programs, or use of MFP facilities or equipment ("Release of Claims")
5. I intend to use MFP facilities and/or equipment outside of MFP's standard operating hours. I recognize and understand that MFP staff are not present in the MFP facilities outside of MFP's standard operating hours. I further recognize and understand that MFP does not provide supervision, instruction, or assistance for the use of the facilities and equipment outside of MFP's standard operating hours and recognize and understand that using the facilities and/or equipment at MFP without supervision, instruction, or assistance may increase the inherent risk and dangers involved in participation in or participating in physical activities.

I recognize and understand that the Release of Claims described in Paragraph 4 applies equally to the use of MFP facilities and/or equipment outside of MFP's standard operating hours. I agree to be solely responsible for my own safety and well-being while using MFP facilities and/or equipment outside of MFP's standard operating hours.
Initial here*
6. I agree to be bound by and obey all the rules and policies of the MFP and MFP staff in my use of the MFP and in my participation in the health and fitness program activities.
7. I agree if any portion of this Membership Agreement is held invalid, the remainder of this form will continue in full legal force and effect.
8. I understand and agree that the law of the State of California will apply to this Membership Agreement, which is intended to be valid and enforceable in the State of California to the greatest extent allowed by law.
9. I understand the information I provided and will provide will be handled in accordance with Mattel's policies applicable to such information and my or my spouse's or family member's employment or engagement with Mattel.
10. I certify that I have read and fully understand the terms and conditions of this agreement.
11. I understand that if I have any further questions or concerns, I will ask for further information.
Name print*
Signature*

Clear
Date*

MonthDayYear
Date
Mattel, Inc. 333 Continental Boulevard, M1-0806, El Segundo, California 90245 | Phone 310.252.2000
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El Segundo Mattel Fitness Place