LaJewell’s Loving Touch LLC “PERKS Program” Enrollment Form

After reviewing the terms, conditions, and benefits of the LaJewell’s Loving Touch LLC “PERKS Program”, I wish to make the following decision (please check one box):

Wish and Do not Wish(Required)

I WISH TO ENROLL in the “PERKS Program” which includes the benefits shown on the flyer (attached) and DEDUCT $5.00 per pay period from my check until such time as I notify the company in writing to do otherwise.

I DO NOT WISH TO ENROLL

Please initial beside each statement to agree to the terms specified. If you do not agree to these terms, conditions, and acknowledgements then your enrollment request will be denied:

statement to agree to the terms(Required)

I have received the “PERKS Program” flyer which explains the program’s current benefits.

I agree that under no circumstances are LaJewell’s Loving Touch LLC or its corporate officer(s) responsible for monetary damages in excess of the total payroll deductions which have been paid during the term of my employment.

I agree that at the sole discretion of LaJewell’s Loving Touch LLC a benefit of the “PERKS Program” may be awarded or denied.

I agree to have any legal actions resulting from this enrollment to be arbitrated in the City Of Martinsville, VA.

I agree to settle any civil action or legal dispute arising from my enrollment in the “PERKS Program” for an amount not-to-exceed the total payroll deductions made during the term of my employment with LaJewell’s Loving Touch LLC.

I agree that benefits of the “PERKS Program” may change (with written notice) at any time in the future. Similarly, I agree that the “PERKS Program” may have benefits added or modified as LaJewell’s Loving Touch LLC determines.

I understand that I may enroll or unenroll with 15 calendar days notice at any time by resubmitting this form (or in writing) to my manager.

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LaJewell’s Loving Touch LLC “PERKS Program” Enrollment Form

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