Silver Sneakers | Power Fitness

We partner with Silver Sneakers Wellness Program. To sign up with us, we will need some basic information and your 16 digit enrollment number from your insurance company. You will need to purchase a key fob (one time fee) to gain 24/7 access. To purchase your key fob, please go to Plans & Pricing Page after you complete the form below. Please fill in the form below.

Silver Sneakers Registration and Gym Liability Waiver

First Name

Last Name

Date of Birth

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Fitness ID Number

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

By selecting this option, you understand and agree to the terms and conditions listed below: Membership is only for the person on the account No guests allowed with this membership No children are allowed in the gym at anytime Do not open the gym doors for anyone at anytime Please be respectful of others and do not talk on the phone or play loud music while working out. Please use earphone accordingly. Proper gym attire is required to include footwear. No open toe shoes, sandals or slides allowed. Lights are motion activated so please do not touch any light switches. You are using the gym equipment at your own risk Ryder Fitness LLC is not responsible for any lost or stolen items Ryder Fitness is not responsible for any illness, injury or death caused as a result of utilizing this premise. You release Ryder Fitness LLC DBA Power Fitness Gym of any and all liability.

Initials

Thanks for submitting!

After you submit your registration and Gym Liability Waver, please call or text: 863-488-9050 to arrange to get your Key Fob.