Dulles Landing 3 Year Agreement


 

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Location:    

 

BUYER/PARENT/LEGAL GUARDIAN’S INFORMATION:

First Name:     Last Name:  

SSN:     Date of Birth:  

Address Line 1:   

Address Line 2:   

City/Town: State: Zip Code:  

Primary Phone Number:     Cell Phone Number:      Work Phone Number: 

Best Time to Contact:     

MEMBER’S INFORMATION:

Member’s First Name:  Member’s Last Name:  Gender:   

Date of Birth:  

SECOND MEMBER – If Applicable:

Member’s First Name:  Member’s Last Name:   Gender:   

Date of Birth:  

THIRD MEMBER – If Applicable:

 Member’s First Name:  Member’s Last Name:   Gender:   

Date of Birth:

FOURTH MEMBER – If Applicable:

Member’s First Name:  Member’s Last Name:   Gender:   

Date of Birth:

EMERGENCY CONTACT INFORMATION:

First Name: Last Name

Relationship:  

Primary Phone:  Secondary Phone:   

COST BREAKDOWN:

Program Monthly Rate:

Total Months Within Contract:

  • 36 Months

Total Amount (Monthly Rate x 36 Months):

Registration Fee ($100.00 Per Member):

Total Cost (Membership Fee Plus Registration Fee Plus Equipment Fee):

  • PLUS Equipment Fee for First Member:   
  • PLUS Equipment Fee for Second Member – If Applicable:   
  • PLUS Equipment Fee for Third Member – If Applicable:   
  • PLUS Equipment Fee for Fourth Member – If Applicable:   

Downpayment (Made Today at Checkout – Two Months of Tuition Plus Registration Fee Plus Equipment Fee):

  • PLUS Equipment Fee for First Member:   
  • PLUS Equipment Fee for Second Member – If Applicable:   
  • PLUS Equipment Fee for Third Member – If Applicable:   
  • PLUS Equipment Fee for Fourth Member – If Applicable:   

Remaining Balance:

Remaining Monthly Payments Owed:

  • 34 Payments

Amount of Monthly Payment:

CREDIT CARD & PAYMENT INFORMATION:

Dragon Yong-in Martial Arts will keep your credit card information securely on file and will not release it to any outside parties.  Your credit card account will be charged automatically each month for the tuition owed in the amount of .

Name on Credit Card (As It Appears):   

Credit Card Type:   Credit Card Number: 

Expiration Date: Verification/Security Code:  

Monthly Date of Charge:  

Please choose a START DATE for your program.  Your program will begin on that day and will last for exactly three calendar years from your selected START DATE.

MEMBER’S RIGHT:
If you wish to cancel this agreement, you may cancel by delivering or mailing by certified mail, return receipt requested, written notice to the School.  
The notice must say that you do not wish to be bound by the agreement and must be delivered or mailed before 12 midnight of the third business day after you sign and receive a copy of this agreement.  The notice must be mailed or delivered to the School at the address shown.  If you cancel, the School may or may not be  entitled to a portion of the total agreement price.  If the School goes out of business and refuses to give a refund, there may be a bond or letter of credit under which you are entitled to collect.  Enforcement of the Health Club Act is by the Attorney General of this State or the district attorney of the county in which the School is located.  If your rights are violated, you may contact the State Bureau of Consumer Protection Agency or your district attorney.  
In consideration for the training obtained, I agree that I will not, during the continuance of this agreement, and for a period of 5 years following the termination of my association with Dragon Yong-In Martial Arts Assoc._, engage in teaching Taekwondo or Hapkido, or offering similar training or instruction within a 25 miles radius of any school operated by Dragon Yong-In Martial Arts Assoc.without the express written authorization of same. 
 
TERMS & CONDITIONS:
1.  MEMBER FITNESS – By signing this agreement, the member represents to the School that he/she has had an opportunity to observe and participate in the program selected by the Member prior to signing this agreement and that he/she is physically and mentally fit to take classes offered by the school in that program or any others selected by the Member.  
2.  UNAVAILABILITY – If the school or its facilities are substantially unavailable for use due to damage or by loss fire, accident, act of God or any other cause, the Member’s program will be extended for a period of time to equal the time of loss of availability, but no refund or credit will be due to the member.  The Member may cancel this agreement if the School closes for more than 30 days and the School fails to provide a comparable facility within then miles of the location designated in this agreement.  Upon notice of cancellation, the School shall refund to the Member all moneys paid in excess of an amount computed by dividing the full contract(daxh) price, including any initiation fee, by the number of weeks in the contract term and multiplying the result by the number of weeks elapsed in the contract term.
3.  LIABILITY WAIVER AND RELEASE – The member understands and agrees that strict observation of the rules and regulations relative to training, including the use of protective equipment, is required and that the use of facilities and the Member’s presence at the School are at the sole risk of the Member.  It is understood and agreed by the Member that martial arts involves defensive and offensive skills and training which include violent and sudden movements and that in connection with the training and instruction session, there will be physical contact between instructors and Members and between and among the Members themselves and that such contact may result in personal injury despite the best intentions and following adequate precautions.  The member agrees that the School and its instructors, agents, employees, operators and authorized representatives, shall not be responsible for and are hereby released from any liability, claim, loss, including loss of property, damage, personal injury, or expense incurred by a Member or anyone claiming through a Member, or related to any activity connected with the School including, but not limited to, any cause by the negligence or gross negligence of the School or its instructors, Members, agents, employees, operators, or authorized representatives.
4.  CLASSES / CONTACT – Scheduling and content of classes and programs and furnishing of facilities and instructors are at the sole discretion of the School and may be changed from time-to-time upon notice by the School.  School agrees to furnish the Member with qualified instructors to teach and supervise classes, practice sessions and contests conducted by the School.  Member understands that during the course of instruction, School instructors, authorized personnel and/or other Members will be engaged in a course of conduct requiring physical contact with the Member.  He/she gives full consent to such contact as is required by the training program and classes.
5.  HOLIDAYS – The Member understands that Classes may not be held on national or local holidays, scheduled vacations or other times as directed by the School.
6.  GUARDIAN – The person(s) signing this agreement as a Guardian agrees to jointly, severally and individually liable as if signing as the Member.
7.  COMPLIANCE WITH LAWS AND REGULATIONS – All rights and obligations of the School and Member under this agreement are subject to all applicable federal, state and local laws and regulations.  When in conflict of this agreement, the contents of such laws and regulations shall be deemed to expressly  modify this agreement and the agreement shall be deemed reworded to incorporate such text as may be necessary in order to make this agreement in compliance therewith.  The School and Member agree to continue to be bound under the modified agreement including such text and further agree that no other modifications shall be deemed made to the agreement.  If any portion of this agreement shall be deemed unenforceable, no other portion shall be unenforceable.  Any waiver or delay by the School or DYMAA in enforcing any right under this agreement will not be a waiver or release thereof.
8.  ACCEPTANCE OF MEMBERSHIP – Upon acceptance as a Member of the School, the Member agrees to faithfully comply with all provisions, terms and conditions hereof, including all rules and regulations of the School.  The School reserves the right to immediately suspend or terminate any Member from participating or enjoyment of rights under this agreement for failure to comply with rules and regulations of the School.  Suspension or termination of a Member shall not entitle the Member to a refund or credit for any tuition already paid or cancels any unpaid balance due.  Examination / Testing fees may not be included in the price of this agreement.
CANCELLATION, DEFAULT OR BREACH OF CONTRACT:
9.  NON-CANCEL-ABLE – The Member understands that after the MEMBER’S RIGHT TO CANCEL expires, the Member cannot cancel this agreement and payments must be made as agreed.
10.  NON-USE – The failure or inability of the Member to use the facilities, classes or services of the School for any reason, will neither relieve nor suspend the Member’s obligation to make all the payments required under this agreement on a timely basis, nor entitle the Member to a refund or credit of tuition.
11.  DISABILITY – The Member may extend the term of the agreement at no additional cost for a period of time equal to the duration of a disability where the Members has a disability precludes the Member from using one-third or more of the facilities for a period of less than 6 months and the disability is verified by a physician.  The Member or his/her legal representative may cancel the agreement if the Member dies or becomes permanently disabled.  A permanent disability means a condition which precludes the Member from using one-third or more of the facilities for 6 months or more and the condition is verified by a physician.
12.  RELOCATION – The Member may cancel this agreement if the Member permanently moves more than 25 additional miles from the School and is unable to transfer the agreement to a comparable facility located within 25 miles of his/her new residence.
13.  CANCELLATION – To cancel this agreement pursuant to any such right contained in the agreement, the Member shall notify the School and DYMAA of cancellation in writing, by certified mail, return receipt requested, or by personal delivery to the address specified in this agreement for the School whereupon any money to be refunded upon cancellation of the agreement shall be paid by the School within 40 days of receipt of the notice of cancellation; and if the Member has executed a credit, lien or automatic funds transfer agreement with the School to pay for the services, any negotiable instrument or credit or lien agreement executed by the Member shall also be returned by the school and any automatic transfer shall be cancelled within 40 days after cancellation.
14.  DEFAULT – Default of this agreement shall constitute non-payment of scheduled monthly payments in excess of 90 days.  If this agreement goes into default, the entire contract balance may be payable upon request.
15.  ADDITIONAL FEES – In the event this agreement goes into default or Guardian/Member breaches the terms of this agreement, DYMAA is entitled to legal fees, court fees, interest and penalties.  At its discretion, DYMAA may charge an additional 20% of the outstanding debt and/or 18% annual percentage rate and penalties to cover additional legal costs associated with collection of this agreement, and may assign this agreement to a national collection agency.
ACKNOWLEDGEMENT:
I have read this agreement and understand that once it is signed by me, it is a legally binding and enforceable obligation and I agree to comply with all the provisions, terms and conditions as this agreement set forth.   I also authorize Dragon Yong-in Martial Arts to charge my credit card each month for tuition that is owed.

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Signature Certificate
Document name: Dulles Landing 3 Year Agreement
Unique Document ID: 35ee4256783f890c1e3de81d7043fb78061538cd
Timestamp Audit
2016-06-16 15:47:54 ESTDulles Landing 3 Year Agreement Uploaded by Dragon Yong-in Sales - sales.dyma@gmail.com IP 108.44.178.160