Centreville, VA Kids Camp Registration Form 2022

Payment Options

Are you currently employed at Life Time?

Yes No

Registrants may choose to pay in full at the time of registration or via scheduled payments.

Scheduled payments are available for all camps regardless of duration of camp.

Scheduled payments will be drafted on the 15th of the month prior to the camp.

The full amount for the corresponding month will be collected in a singular payment.

To participate in scheduled payments, a participant must register on or before the 13th of the previous month. For example: someone registering for a June camp will need to register by May 13th to participate in scheduled payments. Their full June camp payment would be drafted on May 15th.

Amount Due $

Plus any applicable taxes or fees

Payment Options*

Pay in Full on Club Tab (Only available if Club Tab is activated. If not activated, you can activate through your Life Time Member App or in club.) Scheduled Payments

Other payment options may be available if you come to the club before your next dues draft. Club tab is different than your membership dues account.

Paying FULL Authorization

I agree to pay Life Time for the Kid’s Program(s) listed above in the total amount noted above		      (plus applicable taxes) (the “Kid’s Program Fees”). I agree to pay the Kid’s Program Fees in full today unless I have purchased a Kid’s Program(s) on a scheduled payment basis (“Scheduled Payments”) as detailed below.

Signature*

By checking this box, I agree to the payment in full today as stated above.

Scheduled Payments

For Scheduled Payments, I agree to pay my Kid’s Program Fees as scheduled above and authorize Life Time to charge or debit, as applicable, my Monthly Payment Method for each Scheduled Payment.  I authorize Life Time to withdraw or process payment for Kid’s Program Fees or other fees, dues or charges associated with my Kid’s Program(s), including late, invalid payment, or administrative or service fees, from my Monthly Payment Method and any other financial account designated above, or as may be later updated, as my Payment Method. In order to cancel or withdraw my Payment Authorization for Scheduled Payments, I agree to follow the Cancellation and Refund Policies below.
A credit card surcharge may be imposed on Scheduled Payments pursuant to the Credit Card Surcharge Provision included within the terms of this agreement found in the text box located below this text box.

Scheduled Payments*

By checking this box, I agree to the scheduled payments as stated above.

Please read this agreement:

____ Cancellation Policy
•	All cancellation requests must be made through a Notice Method as detailed in the Cancellation and Refund Policies below.  
•	Program Closures or Cancellations.  If a camp or program is not able to operate due to directives provided by local, state, or the Federal Government families will receive a full refund for all camp fees paid returned back in the original form of payment.

_____ Refund Policy. 
•	For scheduled payments, failure to meet payment due date will cancel your registration and advance another camper from the waiting list.
•	Cancellations received 14 days or more before the first day of camp will receive a full refund.
•	Cancellations received by Life Time less than 14 days prior to the first day of the camp will forfeit any paid camp fees.

Parties. This Kid’s Program Registration Agreement (this “Agreement”) describes certain of the terms and conditions that apply to the Kid’s Program(s) that I am purchasing, as summarized above. This Agreement is entered into between myself and LTF Club Operations Company, Inc. (“Life Time”). This Agreement is effective on the date that I sign this Agreement and I agree that I am bound by this Agreement. I acknowledge that the Kid’s Program(s) that I am purchasing are also subject to other agreements or policies, including, without limitation, my participation agreement, member usage agreement and general terms agreement (my “Membership Documents”). 

Kid’s Program(s). I agree that I am purchasing the right to use the number and type of Kid’s Program(s) indicated above. I acknowledge that I am not entitled to receive any additional or different Kid’s Program(s) other than those specified above, and I may not upgrade or otherwise exchange my Kid’s Program(s) for different Kid’s Program(s) or for any other product or service from Life Time. My Kid’s Program(s) have no cash value and are not redeemable or usable for cash except as required by law, and I agree that I will not receive a refund or exchange for any number of Kid’s Program(s) that I have the right to use but that I do not use for any reason, subject to the below Cancellation and Refund Policies. My Kid’s Program(s) are unique to me, and I agree that I cannot sell or otherwise transfer my Kid’s Program(s) to another person.

Payment-Related Terms. I am an account holder and have actual authority to use any financial account designated as my Payment Method. I will promptly update financial account information in the event it changes, and understand that Life Time may use services made available by card issuers to automatically update such information to prevent disruptions due to changes such as an expired or reissued account. I agree that Life Time may resubmit declined or invalid transactions without notice to me. If I fail to timely pay any amount(s) due, I may be assessed a late fee in an amount as permitted by law and/or my Kid’s Program(s) may be restricted. If I submit an invalid payment instrument, such as a dishonored check, I may be assessed a fee in an amount as permitted by law. I agree to pay all collection costs incurred by Life Time, including attorneys or other collection fees. In the event that I am due a refund in accordance with the below Cancellation and Refund Policies, I authorize Life Time to refund the financial account designated as my Payment Method.

Credit Card Surcharge. Unless otherwise prohibited by law, I understand and acknowledge that Life Time may impose and collect a surcharge each time my credit card is charged, whether in payment of Kid’s Program Fees or other fees, dues or charges, whether recurring or non-recurring.  The current surcharge is included within the Club Policies, as it may be updated and revised from time to time. Notwithstanding the foregoing, the surcharge amount shall not be greater than Life Time’s actual cost of acceptance of the credit card or any applicable maximum amount, whichever is less. I further understand that debit cards do not incur any surcharge, and that I may change my Payment Method from a credit card to a debit card at any time online by accessing my member page at mylt.com under “Account” and selecting “Payment Options.”  

Fee Increases. I agree that Life Time may change the amounts and terms of payment at any time in Life Time’s sole discretion, including, without limitation, by increasing my Scheduled Payments, upon such notice, if any, as may be required by law. I also understand and agree that Life Time may increase other fees, dues or charges associated with my Kid’s Program(s) at any time upon such notice, if any, as may be required by law, including late, invalid payment, or administrative or service fees set forth herein or separately in Life Time’s policies, including at www.lt.life. 

CANCELLATION AND REFUND POLICIES
Cancellation by Me for Convenience:
Kid’s Program(s) on Scheduled Payments.  I may cancel my Kid’s Program(s) that is/are on Scheduled Payments by providing a written notice of cancellation in person to the Kid's Program Manager, Member Services Manager or at the Activity Center, by mail to the address of the primary center designated on the General Terms Agreement my membership is under, by mail to Life Time, Attn. Kids Manager 2902 Corporate Place, Chanhassen, MN 55318 or by email to lifetimekids@lt.life ("Notice Method") If Life Time receives my cancellation through any Notice Method at least fifteen (15) days prior to the first day of the applicable Kid’s Program(s), and in such event I will receive a full refund for the amount paid for such Kid’s Program(s). I understand and agree that if a written cancellation notice is received by Life Time less than fifteen (15) days prior to the first day of such Kid’s Program(s), I will forfeit all amounts paid for such Kid’s Program(s) and I will be responsible for all such Kid’s Program(s) payments/fees.  I also understand that failure to make a payment on any due date will cancel my participant’s registration and I will forfeit all amounts paid before such cancellation. 

Kid’s Program(s) Paid in Full (non-Event).  I may cancel paid in full Kid’s Program(s) by providing a written cancellation notice through any Notice Method listed above that is received by Life Time at least fifteen (15) days prior to the first day of the applicable Kid’s Program(s), and in such event I will receive a full refund for the amount paid for such Kid’s Program(s).  I understand and agree that if a written cancellation notice is received by Life Time less than fifteen (15) days prior to the first day of such Kid’s Programs(s), I will forfeit all amounts paid for such Kid’s Program(s) and I will be responsible for all such Kid’s Program(s) payments/fees. 

Cancellation by Me for Cause:
I may cancel the Kid’s Program(s) by providing written cancellation notice, through any Notice Method listed above, due to the Minor Participant’s disability, death and/or relocation. Any amounts I have paid will be pro-rated to the effective cancellation date.  Life Time may require that the disability be confirmed by submission of a physical examination by a doctor agreeable to you and Life Time.  
If Minor Participant cannot attend a Kid’s Program due to an unforeseen medical condition, or government order requiring the Minor Participant be quarantined, I will provide Life Time with as much advance written notice as possible through any Notice Method listed above, along with a doctor’s note confirming the Minor Participant’s unforeseen medical disability (if applicable). Provided Life Time receives such notice, and provided I request a refund from Life Time in such notice, Life Time will issue a prorated refund or credit, at its sole discretion, within 30 days (or such shorter period as may be required by law) of Life Time’s receipt of such notice.

Cancellation by Life Time for Non-Payment.  Without limiting my payment obligations hereunder, or Life Time’s remedies for my failed payment, I understand and agree that if my payment(s) for Kid’s Program(s) is/are not received by the applicable due date, it will result in the cancellation of my registration for the Kid’s Program(s) and the advancement of the next minor participant on the waiting list for such Kid’s Program(s).

Cancellation by Life Time for Any Reason. Life Time reserves the right to cancel Kid’s Programs at any time for any reason including low enrollment, bad weather, unforeseen circumstances, directives from local, state or federal authorities, governmental orders or for any other reason. If a Kid’s Program is cancelled by Life Time, Minor Participant will not be considered as having used it. A refund or makeup session will be granted at Life Time’s sole discretion. Life Time will issue any such refund for the dollar value of the missed session(s), within 30 days (or such shorter period as may be required by law).

Missed Kid’s Program. Subject to the Cancellation and Refund policies above, if a Minor Participant cannot attend any Kid’s Program(s), I understand and agree Minor Participant will be considered as having used such Kid’s Program(s), and will not be entitled to participate in similar or the same Kid’s Program(s) on a later date as a makeup session or be given a refund.   

PARTICIPATION POLICIES
Current Membership in Good Standing. As a condition to being eligible for Minor Participant to be registered for Kid’s Programs that are included in my club membership for no additional cost, I agree that my club membership must be current and in good standing. 
Kid’s Program Professionals.  Life Time reserves the right to substitute instructors, trainers or other Kid’s Program professionals as necessary or appropriate in order to perform the Kid’s Program(s).

KID’S PROGRAM FEE POLICIES 
Camp Fee Policy. All Kid’s Programs that are camps have two payment options: full payment at the time of registration or full payment deferred to the 15th of the month prior to the start of camp as a Scheduled Payment. Kid’s Program camp registration must be received by the 13th of the month prior to the start of the camp to be able to defer payment as a Scheduled Payment, otherwise, payment is due in full. Payment for multiple camp registrations on the same transaction must be made with the same Payment Method for each. Failure to make a payment when due will result in Life Time cancelling any applicable registration(s). 

GENERAL POLICIES
Electronic Communications.  I expressly consent to receive electronic messages from Life Time, including messages to advertise or promote products or services and messages related to my Kid’s Programs, including but not limited to communications related to Life Time’s fees, dues and other charges.

Club Policies.   The Club Policies, including the Guest & Club Policies, the Terms of Use and the Privacy Policy, establish policies, procedures, rules, regulations and other terms applicable to Life Time members and guests. Life Time's Club Policies are located on or referenced within its corporate website, which is currently www.lifetime.life. I agree that it is my responsibility to know and follow the most current Club Policies. For California residents, please review https://my.lifetime.life/policy/ca-privacy-policy.html for information about our privacy practices, including the information we collect and your rights relating to your information.  

Image and Likeness Release. I understand that Life Time, or an authorized third party of Life Time, may take photographs, audio or video recordings, or testimonial accounts that may contain the name, image, voice, likeness or account of me or the Minor Participant(s) (collectively “Images”) during the use of the Kid’s Program(s). On my and each Minor Participant’s behalf, I hereby irrevocably consent to and grant Life Time the exclusive, worldwide, perpetual, royalty-free and otherwise unlimited right to use, copy, modify, distribute, publicly display and perform, publish, transmit, remove, retain, repurpose, and commercialize any and all such Images (and the right to sublicense such images through unlimited levels of sublicensees) in any and all media or form of communication whether now existing or hereafter developed, without obtaining additional consent, without restriction or notification, and without compensating me or the Minor Participant(s) in any way, and to authorize others to do the same. Without limiting the foregoing, I hereby consent, on my and each Minor Participant’s behalf, to Life Time’s use of the Images for commercial and promotional use, including on corporate or employee social media. Life Time may change, modify, rearrange, add, delete or otherwise alter such Images. I hereby waive, on my and each Minor Participant’s behalf, any right to inspect, approve, or edit such Images as used by Life Time.

Assumption of Risk, Waiver of Liability and Indemnification. I understand and agree that the Kids Program(s) involves risks of injury or damage. I elect for the Minor Participant(s) listed above to participate in the Kids Program(s), which includes the use of Life Time premises, facilities, services, equipment, products and activities and may include participation in off-premises activities voluntarily in spite of the risk. I further understand and agree to all of the terms and conditions of this Agreement and that the terms of my Membership Documents apply to the Kids Program(s) and the Minor Participant(s), including the assumption of risk, waiver of liability, defense and indemnification provisions contained therein.

ARBITRATION AGREEMENT WITH CLASS ACTION WAIVER 
a)	Mandatory Binding Individual Arbitration. Except as expressly provided below, Life Time and I, including on behalf of each Minor Participant (each a “party” or, together, “us,” “we” or “parties”) agree that any dispute, claim, case, or controversy (whether based in tort, contract, statute, regulation, ordinance, equity or any other legal theory) between us (whether arising out of or relating to past, present or future acts or omissions) (“Claims”) shall be exclusively resolved by binding arbitration on an individual basis, rather than in court (“Arbitration Agreement”).
b)	Waiver of Class Actions. We each agree that we will assert Claims in arbitration only in our individual capacity, and not as a representative or member of any purported class.  We each agree that we will not participate in any class, mass, collective, consolidated, private attorney general or other representative arbitration proceeding. Each party agrees that the arbitrator has no authority to arbitrate Claims on a class-wide basis and shall not consolidate, combine, or jointly arbitrate Claims of more than one person in a single arbitration.
c)	Waiver of Jury Trial. We waive our constitutional and statutory rights to go to court and have a trial in front of a judge or a jury, electing instead to resolve by binding arbitration all Claims.
d)	Claims Not Subject to Arbitration. There are only three exceptions to this Arbitration Agreement:
i)	Small Claims. Either party may bring individual Claims in small claims court.
ii)	Personal Injury Claims. Both parties must litigate personal injury Claims in court.  For purposes of this exception, personal injury Claims are Claims arising from injury to the physical structure of the human body.  
iii)	Emergency Equitable Relief. Either party may seek temporary injunctive relief or other equitable relief in court pending arbitration. A request for interim measures will not be deemed a waiver of any other rights or obligations under this Arbitration Agreement.
e)	Arbitration Procedures. Either party may initiate an arbitration proceeding, which will be conducted by a single neutral arbitrator.
i)	Arbitration Providers. Each party has a choice of initiating arbitration before either the American Arbitration Association (“AAA”) or JAMS, which are both established alternative dispute resolution providers (“ADR Providers”). If neither AAA nor JAMS is available to arbitrate, we will agree to select an alternative ADR Provider to administer the arbitration in this Arbitration Agreement.
ii)	Arbitration Rules. The arbitration will be conducted under the AAA Consumer Arbitration Rules (available at www.adr.org) or JAMS Streamlined Arbitration Rules and Procedures (available at www.jamsadr.com) (“Arbitration Rules”). The rules of the ADR Provider will govern all aspects of the arbitration, except to the extent such rules are in conflict with this Arbitration Agreement.
iii)	Arbitration Location. The arbitration hearing will be held at the ADR Provider’s location that is closest to the claimant’s primary residence, unless the claimant primarily resides outside the United States (in which case the arbitrator will give the parties reasonable notice of the date, time and place of any oral hearings.)
iv)	Fees. Payment of all filing, administrative, and arbitrator fees will be governed by the Arbitration Rules.
v)	Arbitrator’s Authority and Award. The arbitrator will decide the rights and liabilities, if any, of the parties, and the dispute will not be consolidated with any other matters or joined with any other cases or parties. The arbitrator will have the authority to grant motions dispositive of all or part of any Claim. The arbitrator will have the authority to award monetary damages, and to grant any non-monetary remedy or relief available to an individual under applicable law, the ADR Provider’s Rules, and this Arbitration Agreement. The arbitrator will issue a written award and reasoned statement of decision describing the essential findings and conclusions on which the award is based, including the calculation of any damages awarded. The arbitrator has the same authority to award relief on an individual basis that a judge in a court of law would have. Any award will be subject to judicial confirmation or entry in any court having jurisdiction.
f)	Governing Law. This Arbitration Agreement is governed by the Federal Arbitration Act and federal arbitration law.
g)	Confidentiality. All aspects of the arbitration proceeding, including but not limited to the award of the arbitrator and compliance therewith, will be strictly confidential. The parties agree to maintain confidentiality unless otherwise required by law. This paragraph will not prevent a party from submitting to a court of law any information necessary to enforce this Arbitration Agreement or to enforce an arbitration award.

OTHER PROVISIONS
This Agreement supersedes and replaces any prior oral or written agreements (but not my Membership Documents) or other communications between me and Life Time with respect to the Kid’s Programs. I am not relying on any oral or written promises, representations, statements, covenants or warranties, other than those set forth or incorporated herein, to induce me to sign this Agreement. This Agreement may be amended, terminated or assigned at any time by Life Time upon such notice, if any, as may be required by law. If Life Time fails to enforce any right in this Agreement for any reason, Life Time does not waive its right to enforce it later.

IF PERSON IS UNDER 18 YEARS OF AGE, A PARENT OR LEGAL GUARDIAN MUST COMPLETE THE FOLLOWING:
BY ACCEPTING THIS AGREEMENT (WHETHER BY CLICKING TO ACCEPT ONLINE, BY SIGNING A SIGNATURE PAD IN CLUB OR OTHERWISE), I, the undersigned Parent, Legal Guardian, or Authorized Adult, have read, understood, and received a copy of this Agreement, including specifically the binding arbitration agreement with class action waiver, and hereby knowingly and voluntarily execute the foregoing for and on behalf of myself and the Minor Participant and agree to bind myself, the Minor Participant and any heirs, next of kin, assigns or personal representatives to such terms. Minor Participant will receive the privilege of participating in the Kids Program(s), and I agree that he or she will abide by all rules, regulations and policies of Life Time, which are subject to change without notice. I represent that I have full legal authority to act for and on behalf of the Minor Participant, and I agree to indemnify, defend and hold harmless Life Time, Inc. and its subsidiaries for any expenses, claims or liabilities that may arise as a result of any insufficiency of my full legal authority to execute the foregoing.

I have read, understand and received a copy of this Agreement, and have knowingly and voluntarily signed it.*

By checking this box, I agree to pay the amount due (plus applicable taxes or fees) and to all terms and conditions as stated above.

Dates	Time	Fee

Monday, January 17th (Martin Luther King Jr. Day)	Full Day (8am-6pm)	$48 / Day

Friday, January 21st	Full Day (8am-6pm)	$48 / Day

Monday, January 24th	Full Day (8am-6pm)	$48 / Day

Dates	Time	Fee

Monday, February 21st (Presidents Day)	Full Day (8am-6pm)	$48 / Day

Dates	Time	Fee

Friday, March 4th	Full Day (8am-6pm)	$48 / Day

Dates	Time	Fee

Monday, April 4th - Friday, April 8th (Full Week)	Full Day (8am-6pm)	$200 / Week

Friday, April 1st	Full Day (8am-6pm)	$48 / Day

Monday, April 4th	Full Day (8am-6pm)	$48 / Day

Tuesday, April 5th	Full Day (8am-6pm)	$48 / Day

Wednesday, April 6th	Full Day (8am-6pm)	$48 / Day

Thursday, April 7th	Full Day (8am-6pm)	$48 / Day

Friday, April 8th	Full Day (8am-6pm)	$48 / Day

Dates	Time	Fee

Monday, May 30th	Full Day (8am-6pm)	$48 / Day

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