Name *

First Name

Last Name

FULL PRICE CHECKLIST - if 3 or more of the following are true, I am not eligible for financial support. Check all boxes that apply.

I am able to meet my basic needs (food, housing, transportation).

I am able to pay my rent, or I own my home or property.

I am employed.

Although it might be tight, I am able to spend some of my income on fitness, shopping, travel, entertainment, or eating out.

I have access to financial support through family, savings, or other resources in times of need.

I have attended or currently attend higher education.

I am pursuing my passion, or higher education, and have limited income by choice.

None of the above.

FINANCIAL SUPPORT CHECKLIST - If 2 or more of the following are true, I am likely eligible for financial support. Check all boxes that apply.

I do not have access to financial support from other resources, such as a partner’s income, family, or investments.

I have a disability that impacts my ability to work/earn money.

I live in a NYCHA building.

I am on food stamps.

I am on Medicaid.

I am a refugee.

None of the above.

Please confirm ALL OF the following statements by checking the corresponding boxes:

I will visit the front desk in October during public hours to activate my membership.

If I have a current auto-pay membership, it is my responsibility to terminate it before being charged my regular rate before my next billing date.

I will pay for my part of the membership when I come into VITAL to activate my membership.

I acknowledge that I cannot activate my membership until October 1 or later.

I will use my membership in October, primarily at my Home Gym (the location to which I am currently applying).

To be considered for future support, I must reapply again in the application window from the 4th Monday of the month onward.

I acknowledge my membership will be active for 30 days from the date I visit the front desk.

I have filled out the waiver.

How much support are you requesting? Please note the allotment of scholarships and apply only to the level you need. Applicants who request more than one support level will be ineligible:

75% off

50% off

25% off