PUMPT 24/7 Gym Membership Form & Waiver

PUMPT 24/7 Membership & Guest Pass Form

Completion of this form means you acknowledge and agree to the terms and conditions set out in this form regarding your guest pass and/or membership at PUMPT 24/7 at 10/20 Merchant Drive Rockingham WA 6168.
Member Full Name*

First NameLast Name
Parent/Guardian Full Name (if member is under 18)

First NameLast Name
Date of Birth*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number*

Phone Number
Phone Number*
04XX-XXX-XXX
Email*
example@example.com
Gender*

MaleFemaleNon-BinaryPrefer not to discloseOther
Emergency Contact Information
Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Phone Number*
04XX-XXX-XXX
Relationship*

How did you find out about PUMPT 24/7?*

FriendFamilyInstagramGoogleFacebookOther
Comments (ie. who/what encouraged you to sign up?)

Medical Questionnaire

Do you have or have you had any of the following? (Please respond Yes or No to all questions)
Heart disease or any cardiovascular condition?*
Any major illness or surgery in the last 5 years?*
High Blood Pressure?*
Diabetes?*
Epilepsy?*
Asthma or difficulty breathing?*
Dizziness, or blackouts?*
Arthritis or muscle pain?*
Are there any other conditions or medical problems which may be reason to modify your training program? (Write N/A if No)

“Pumpt Playpen” (Creche) & Children Policy
PUMPT 24/7 is delighted to provide a safe and enjoyable space for your little ones while you focus on your fitness journey. To ensure a pleasant experience for everyone, we have established the following children’s policy & disclaimer.
- Creche hours: Children are permitted in the creche area only when the creche is staffed. Please refer to our schedule for creche hours and pricing. The creche will be closed outside of these hours.
- Gym floor access: For safety reasons, children are not allowed on the gym floor. However, babies in prams are permitted with their parent/guardian during designated quiet times in the gym.
- Supervision: Our staff are dedicated to supervising while your child is in the creche in a fun, interactive and safe space. Staff are not responsible for feeding, administering medication or nappy changes. No food is allowed in the creche to ensure we keep children safe from potential allergens.
- Parent/Guardian Responsibility: Parents/guardians are responsible for their child’s well-being and must remain on the gym premises while their child(ren) are in the creche. In the event of any emergency, staff will follow designated procedures to ensure the safety of all children and will notify parents immediately. Participation is at your own risk. The gym is not liable for any injuries or accidents that may occur.
- Age Limit: The play area is designed for children up to 12 years of age.
- Respectful behaviour: Children are expected to treat staff, other children and equipment with respect. Rough play, fighting or disruptive behaviour will not be tolerated.
- Personal belongings: Parents/guardians are responsible for their child’s personal belongings. The gym is not liable for any lost or damaged items.
- By entering your child into the creche, you hereby acknowledge and agree to abide to these rules and disclaimers. Failure to comply may result in expulsion from the creche or gym premises.
I have read and understood the terms of the Pumpt 24/7 Creche and Children Policy*

Pet Policy
PUMPT 24/7 is a dog-friendly gym space. Dogs are to remain on leash while inside the gym premises.
- Pet behaviour: owners are responsible for ensuring their pets behave appropriately at all times. Aggressive behaviour towards other pets or members will not be tolerated.
- Clean-up: Owners are required to clean up after their pets. This includes disposing of any waste and ensuring that shedding hair is vacuumed up after their visit.
- Respect for others: Please be mindful of other gym members and their pets. Keep a safe distance from other dogs and seek permission before approaching with someone else’s pet.
- PUMPT 24/7 and its staff are not liable for any incidents involving pets or their behaviour. Owners are solely responsible for their pets and any consequences arising from their presence in the gym.
I have read and understood the terms of the Pumpt 24/7 Pet Policy*

PUMPT 24/7 Gym Use & Recovery Cave Policy
The use of the PUMPT 24/7 & the Recovery Cave facilities, including the ice bath and sauna, is entirely at your own risk. PUMPT 24/7 and its staff are not liable for any injuries, accidents, or incidents that may occur during or as a result of your use of the facilities.
- Non-Staffed Hours: The Gym offers 24/7 access to members, the gym premises including the Recovery Cave may be accessible during non-staffed hours, such as on weekends or holidays. During these times, it is your responsibility to ensure your own health and safety. Please use caution and adhere to all safety guidelines provided.
- Duress Alarm: For your safety, duress alarms are installed by the front counter and in the Recovery Cave. In the event of an emergency or if you require immediate assistance while training or using the facilities, activate the duress alarm. This will alert gym owners and prompt the dispatch of emergency services (ambulance) to the gym premises. Please note that misuse of the duress alarm which results in unrequired alerting of authorities may incur a fine payable by the presser of the duress alarm.
- Supervision: It is recommended to use the Recovery Cave facilities under supervision/with a friend. If you have any underlying health conditions or concerns, please consult a medical professional before using the facilities.
- Health Precautions: Before using the ice bath or sauna, please familiarize yourself with the proper usage guidelines and ensure that you are in good health to do so. Avoid prolonged exposure and stay hydrated during and after your session. By using the Recovery Cave facilities, you acknowledge and accept the terms of this disclaimer.
I have read and understood the terms of the Pumpt 24/7 Gym & Recovery Cave Policy*

Membership Pause & Cancellation Policy
No lock in contract or cancellation fee. In order to cancel you must complete our cancellation form and return your access token to the premises.

Pausing memberships: if you wish to pause your membership, regular payments will be suspended and instead a $5 per week fee will be charged to hold your membership while you are away. Note: This fee does not extend to defence force personnel who are away from the gym due to deployment (ie out at sea).
I have read and understood the terms of the Pumpt 24/7 Pause & Cancellation Policy*

Membership Acknowledgement

By signing this agreement you acknowledge that you have received and read the copy of membership agreement and liability release.

By signing this agreement you also agree to accept the terms and conditions of this agreement in this entirety and to be bound by the conditions for the duration of your membership.

RISK OF INJURY – I acknowledge that if I am injured on PUMPT 24/7 property or during any PUMPT-sponsored event, I will hold harmless Club Owner and all PUMPT24/7 staff members.

I take full responsibility for myself and any guests while they are with me while on PUMPT 24/7 property.
Member Name*

First NameLast Name
Parent/Guardian Full Name (if member is under 18)

First NameLast Name
Please upload a selfie/headshot for your membership profile

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Signature of Member or Parent/Guardian*

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Date*

DayMonthYear
Date
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PUMPT 24/7 Membership & Guest Pass Form

Emergency Contact Information

Medical Questionnaire

Membership Payment Terms