Guest Waiver "*" indicates required fields ATTENTION:You will be unable to submit the form. Error: No Club Number is associated to the form. Please go to Location Selector to re-apply the location number and continue, thanks.Personal InformationName* First Last Email* Phone*Contact Method* Call Text Email Gender* Male Female Other Birthdate* YYYY dash MM dash DD Street Address* City* State*AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyomingPostal Code* How Did You Hear About Us* Facebook Instagram Physiq Website Drive By Member Referral TV/Streaming Commercial Google Search QFit Member Guest Premium Member Guest Day Pass What best describes your fitness journey?* It's my first time joining a gym When I think fitness, I think Physiq Fitness! I want to stay fit, and look my best this year I want to escape to the gym for some "Me Time" I'm ready for a lifestyle change, looking to work with a Personal Trainer or take Group Classes I'm a former athlete, trying to get back in shape I'm proud of my fitness level, looking to maintain as I age What is your current fitness goal?* Lose 15 or more Lbs. of Body Fat Gain Muscle/Weight Cardio/Heart health Injury Rehabilitation Other When do you need to accomplish this goal by?* In the next 3 months 3 to 6 months from now 6 to 9 months from now 12 months from now I have a specific date in mind So we can provide you with the best membership experience, please let us know what you're interested in. (Select ALL that apply)* Multi-Club Access Fitness Coaching Exclusive Workout Room Group Exercise Classes (GGX) Bring a Workout Partner Injury Rehab Assistance Nutrition Counseling Massage Chairs Lifting Platforms Functional Turf Area Tanning Beds Punching / Boxing Bags Cardio Movie Theater Juice / Smoothie Bar ConsentAs a Guest of Physiq Fitness, I acknowledge that physical activity and the use of exercise equipment, club facilities, club programs, tanning beds, fitness instruction, and other services could result in illness, injury, or theft of personal property. I hereby affirm that I am a voluntary participant in these activities and assume all associated risks. Furthermore, I release and hold harmless the officers, staff, agents, and assigns; from all claims should any injury, illness, or loss occur. I am hereby advised to consult a physician before undertaking any exercise program. My signature below indicates that I have carefully read this waiver and agree to its terms and conditions.Terms and Conditions* I agree to the above terms Physiq Fitness is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you:I agree to receive other communications from Physiq Fitness. I agree to receive other communications from Physiq Fitness. You can unsubscribe from these communications at any time. For more information on how to unsubscribe, our privacy practices, and how we are committed to protecting and respecting your privacy, please review our Privacy Policy. By clicking submit below, you consent to allow Physiq Fitness to store and process the personal information submitted above to provide you the content requested.Signature*HiddenClub Location557772627239555740131Hiddencard number Take your photo