Carle Health & Fitness Center Membership Adjustment

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If you wish to make adjustments to your current Carle Health & Fitness Center membership, please fill out the following form. We ask that all adjustments are made using this form to free up our member services staff to help keep our center clean and safe.

If you have any additional questions or concerns, please include them at the bottom of this form. We will respond to your request shortly. Thank you for being a member!

Email *

First and Last Name (as listed on membership) *

Phone Number (Please use preferred number) *

Membership Adjustment Type (for additional details see "Membership Freeze Status Information" below) *

"WELLNESS ANYWHERE" Membership: You will not have physical access to the center but will have access to LIVE at home workouts, On Demand Virtual Library, communication with your Fitness Coach and more. View full details of this membership option at http://www.carlehealthfitness.com/wellness-anywhere/

Temporary Membership Freeze: You will not have physical access to the Center or virtual "members only" programming. (Valid up to 3 months)

Medical Membership Freeze (w/physician's note ONLY): You will not have physical access to the Center or virtual "members only" programming. (Valid up to 6 months)

Length of Membership Adjustment (reminder these are consecutive months) *

1 month

2 months

3 months

4 months (Valid for "Wellness Anywhere" Membership or Medical Freeze w/physician's note only)

5 months (Valid for "Wellness Anywhere" Membership or Medical Freeze w/physician's note only)

6 months (Valid for "Wellness Anywhere" Membership or Medical Freeze w/physician's note only)

Reason for Membership Freeze *

*Membership Freeze Status Information

All adjustments to memberships MUST be made prior to the 20th of the month to ensure that you are not charged. Any requests made after this date will not be in effect until the next billing cycle.

Changes to Membership Status

Temporary Suspension/Freeze Status. I may apply for a “Temporary Suspension/Freeze” of my membership for a minimum period of one (1) month, up to a maximum of three (3) months, and no more often than once every calendar year by: (i) giving advance written notice to the Wellness Center; and (ii) paying all dues and other unpaid charges due at the time of the commencement of the suspension/freeze.

Medical Suspension/Freeze Status. I may apply for a “Medical Suspension/Freeze” of my membership for a period of two (2) months, not to exceed six (6) months, provided: (i) I provide the Wellness Center with a note from a licensed physician before the commencement of the suspension/freeze; and (ii) I pay all dues and other unpaid charges due at the commencement of the suspension/freeze. A note from a licensed physician will be required in order to reinstate my membership and to begin using the Wellness Center following my suspension/freeze.

Notes on Effect of an Approved Suspension/Freeze: During an approved suspension/freeze, I, and any secondary members listed on my account, may not use the Wellness Center. The term of this Membership Contract will be extended by the period of the approved suspension/freeze. No dues shall accrue during the suspension/freeze.

I understand that membership freezes/adjustments are allowed once per annual membership. By adjusting my membership at this time I agree to the Freeze Status Terms as noted above.* *

I agree

I disagree

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Any additional questions/comments or information you would like to include?

A copy of your responses will be emailed to the address you provided.

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