YMCA Fitness Health Form (U18) Logo
  • Fitness Health Form

    (Under 18)
  • Take the first steps to getting your YMCA Gym membership started by filling out the form below. 

    Once you submit the form, book an U18s youth induction with our gym team by visiting us in person or giving us a ring on 0191 257 5434 (option 2) then you will be able to buy your membership and start using the gym.

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  • Health Check:

    For most people physical activity should not pose any problem or hazard. This health questionnaire has been designed to identify the small number for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them
  • Declaration

    I confirm that the information above is correct. I agree to inform an instructor in the event that the answer to any of the above questions should change. I also agree to use only the equipment which has been demonstrated to me by an instructor and will seek advice about the use of any equipment where I am unclear about its safe use. I understand that the YMCA and its employees will not accept liability for injury caused to me where such injury is the result of my failure to use the equipment properly: my failure to seek advice about the proper use of the equipment: or my failure to inform YMCA of my actual health status: or otherwise as a result of my or a third party’s negligence.
  • Customer

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  • Parent/Guardian

    If you are under 18 years of age we require permission from a parent/guardian for you to use our facilities.
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  • Emergency Contact Information

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  • Should be Empty: