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For general information about how we handle personal information of California residents, please see our Privacy Policy. Required fields are marked with an asterisk*. If we require more information from you, or need clarification about the nature of your request, we will contact you at the email you indicated below. Please note: this form should be used to make Consumer Requests with Ultimate Fitness Group, LLC and its affiliates (which include the franchisor of the Orangetheory� Fitness brand). If you would like to make a request with one of our independently owned and operated franchisees, please contact the franchisee directly. 1. * California Residency Are you a California resident? By clicking yes below, you certify and declare under the penalty of perjury that you are a resident of California: Yes 2. * Relationship to Consumer Self Parent/Guardian Authorized Agent If you are a parent/guardian submitting a request related to your minor children, please see sections 15-18 and 20 below for additional information you must provide. If you are an authorized agent, please see sections 15-18 and 21 below for additional information you must provide. 3. * Request Type Request to Know Specific Pieces of Personal Information Request to Know Categories of Personal Information Do Not Sell My Personal Information Request to Delete My Personal Information If you have multiple requests, please submit a separate form for each request. 4. * Consumer's First Name 5. Consumer's Middle Initial 6. * Consumer's Last Name 7. * Consumer's Email Address 8. * Consumer's Phone Number 9. * Consumer's Country 10. * Consumer's State 11. * Consumer's Postal Address 12. * Consumer's City 13. * Consumer's Zip code 14. * Relationship to Orangetheory Maintains Account Membership (Active Member) Former Member No Account Membership 15. Requestor's First Name (only complete if selected authorized agent or parent/guardian above in #2) 16. Requestor's Last Name (only complete if selected authorized agent or parent/guardian above in #2) 17. Requestor's Email Address (only complete if selected authorized agent or parent/guardian above in #2) 18. Requestor's Phone Number (only complete if selected authorized agent or parent/guardian above in #2) 19. * Preferred Method of Response Delivery Secure Electronic Delivery Physical Mail 20. Parents/Guardians If you are a parent/guardian submitting a CCPA rights request related to your minor child, please email a written notarized statement under penalty of perjury (and fraud) that you are the guardian of the minor whose CCPA rights you are seeking to exercise. If you do NOT provide the signed notarized statement, we cannot honor any request you submit on behalf of a minor child. After submitting your request through the webform, please email your notarized statement as an attached PDF to privacy@orangetheoryfitness.com. The subject line of the email should read as "Parent/Guardian - Notarized Statement - [Request ID]". The Request ID must be included and will be displayed after this web form is submitted. 21. Authorized Agents If you are serving as an authorized agent for a California consumer, please email a written notarized authorization form from the consumer that you represent, or a Power of Attorney document, authorizing you to serve as the consumer's agent for the purposes of exercising the consumer's rights under the CCPA. If you do NOT provide the signed authorization, we cannot honor any requests you submit on behalf of a consumer. After submitting your request through the webform, please email your notarized statement attached as a PDF to privacy@orangetheoryfitness.com. The subject line of the email should read as "Authorized Agent - Notarized Authorization - [Request ID]". The Request ID must be included and will be displayed after this web form is submitted. Cancel Submit Request 2019 All rights reserved. Beginning January 1, 2020, California residents may use this form to submit requests under the California Consumer Privacy Act. This form is under construction and will not be functional before January 1. Any requests submitted before January 1 cannot be accepted while we configure our systems. California residents may begin submitting requests on January 1.