Peterborough Gym Membership Application

Once you submit your form, one of our team will be in contact within 48 hours to advise on payment.

What do you want to achieve by using our facilities?*

Weight LossImproved strength or muscle sizeImproved health & fitnessOther

Are you new to exercise or an irregular exerciser who has never really achieved their goal through exercise before?

YesNo, I know what I am doing and have achieved my goal before

Name (please also include Title):*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

I would like to be kept up to date with YMCA Gyms activities and promotions by email:*

YesNo

Date Of Birth*

Age

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Area CodePhone Number

Please indicate which membership you wish to purchase:*

Adult Membership (16 - 59) £26.75Concessions £18.43 - student, Low Income, 60+, disabilityYouth (13 - 15) £18.43Hostel Resident £5.00

What prompted you to join our gym today?

Self-screening form (adults only)

This questionnaire has been devised as a safety precaution to identify any individuals who may be putting themselves at risk by starting an exercise programme without medical advice.

Please answer the following questions:

Have you suffered from a heart condition or high blood pressure?*

YesNo

Do you suffer from chest pains?*

YesNo

Are you troubled with joint pains, severe back pains or arthritis?*

YesNo

Are you recovering from a serious illness or operation?*

YesNo

Are you pregnant or have had a baby within the last 6 months?*

YesNo

Do you suffer from diabetes?*

YesNo

Do you suffer from asthma?*

YesNo

Do you suffer from fits or blackouts?*

YesNo

Are there any other factors not mentioned above that may be aggravated by exercise?*

YesNo

If you have answered yes to any of these questions we strongly advise that you consult your Doctor before taking part in any physical exercise.

I do not wish to have an induction and by ticking this I am agreeing I have adequate knowledge of using gym equipment and will take sole responsibility for my actions.*

I do not wish to have an induction and agree with the statement aboveI would like to have an induction

Signature*

TERMS AND CONDITIONS

Memberships and payments

1. Membership fees must be paid by Direct Debit instalments and are payable on the 5th day of each month of membership. Your first Direct Debit will depend on your joining date. It will either be on the 5th of the following month or the month after. This date will be made clear to you on joining.

2. There is no contract you are free to cancel your Direct Debit at any time. We advise that all members may cancel their direct debit themselves through online banking or by contacting the bank.

3. In the event of gym closure e.g. Government issued lockdown. You MUST cancel your membership yourself to ensure payments are not taken out.

4. If you decide to cancel your membership, you must allow at least 7 days before the 5th of the month to ensure your payment is cancelled and advise Reception of the cancellation.

5. If you are paying by Direct Debit and you fall behind with your membership fees, we may charge reasonable administration fees or suspend or cancel your membership if this is not caused by bank error; and we may pass your details to a debt-collection company to recover any outstanding payments.

6. For concessionary membership you will be required to provide proof that you are eligible, either studying or in receipt of Benefits, pensions etc. A list of qualifying criteria is available on request. You will be asked to provide proof every few months.

7. We may decide to increase our membership fees; in which case YMCA will give you a minimum of 30 days’ notice of any fee change.

8. YMCA has the right to cancel any membership for unacceptable behaviour towards staff or other users; or for ill treatment of equipment including the dropping of weights.

I confirm that I have read, understood and accept the above terms and conditions:*

I confirm

Signature*

Name*

First NameLast Name

Date*

Date

For information on how we handle your data please read our privacy policy on our website - Gyms Privacy Policy

YMCA Gym Peterborough Membership Application