Membership Form

Name:*

First NameMiddle NameLast NameSuffix

Date of Birth:*

Date

Phone Number*

Please enter a valid phone number.

Email:*

example@example.com

Current address:*

Street Address

Street Address Line 2

City/townCounty

Post code

Photo Identification:*

To prevent misuse and ensure security, we require all members to upload a clear portrait photo for verification. This photo will be stored in your MindBody account and will not be shared with third parties in accordance with our Privacy Policy.

Name:*

First NameLast Name

Phone Number:

Please enter a valid phone number.

Relationship to Member:*

Referral Type:*

Membership Type:*

Annual Adult (16+) MembershipAnnual Adult (16+) Membership: ConcessionNursery@Aspire Parent MembershipStaff Membership: Southfields Academy or Linden Lodge Staff OnlySenior Membership (60+)Club Membership

Proof Required:

Please upload a picture of proof required for the membership type you have chosen.

We accept the following as proof:

Annual Adult (16+) Membership: Concession – valid and up to date Key Worker ID
Staff Membership: Southfields Academy or Linden Lodge Staff Only – valid Staff ID
Senior Membership (60+) – valid photocard driving licence (full or provisional) or a passport with visible photo and Date of Birth proving your age
Nursery@Aspire Parent Membership – proof provided by the Nursery manager

Asthma*

YesNo

Bronchitis*

YesNo

Arthritis/joint pains*

YesNo

Heart condition*

YesNo

Diabetes*

YesNo

Epilepsy*

YesNo

Back problems*

YesNo

High/low blood pressure*

YesNo

Eating disorder*

YesNo

Pregnant or given birth in last 6 months*

YesNo

Physical disability*

YesNo

Are you taking any medication?*

YesNo

Please give more details to your condition(s):

If you have responded affirmatively to any of the aforementioned conditions, we strongly recommend that you consult your medical practitioner before engaging in any type of physical activity. By affixing your signature to this document, you affirm the accuracy of all your responses.

In the event that I have been advised to obtain medical clearance prior to participating in exercise, I commit to reaching out to my general practitioner (GP) and taking on the responsibility of securing written consent prior to commencing any exercise regimen. I acknowledge that I am accountable for self-monitoring, and should any atypical symptoms manifest, I will promptly discontinue my participation and inform my physician of said symptoms. I am aware of the necessity to inform the instructor about any alterations in my health status.

I verify that my involvement in physical activities at Aspire@Southfields (trading as Aspire Centre) is entirely voluntary, and I recognise that neither Southfields Academy, Aspire Centre nor its staff can be held liable for any accidents or personal injuries that occur during the use of facilities or arise from such use.

By endorsing this declaration, I pledge to responsibly and comfortably adhere to the recommended exercise/activity regimen and acknowledge the availability of a fitness suite induction upon the acquisition and payment of my membership fees.

Account management*

EmailTextNeither

Reminders and schedule changes*

EmailTextNeither

News and promos

Email

Due to privacy considerations, customers are required to personally opt in to receive promotional text messages via MindBody account.

You can change these preferences at any point through your MindBody account.

Signature*

I hereby provide my consent for the utilisation of the information supplied in this form within the MindBody cloud-based software system, as employed by Aspire@Southfields (trading as Aspire Centre).

Membership Form

Member Details

Emergency Contact

PAR-Q: Health & Fitness Disclaimer

Communication Preferences