PAY UPFRONT GYM MEMBERSHIP REGISTRATION FORM

Description: PAY UPFRONT MONTHLY MEMBERSHIP OPTIONS AS FOLLOWS (to be paid in person at the gym, eftpos available): 1 Mnth - $100, 3 Mnths - $266, 6 Mnths - $482, 9 Mnths - $715, 12 Mnths - $900, Casual Week Pass - $50/wk (24 hr access granted) TO BE PAID IN PERSON AT THE GYM. PLEASE TYPE YOUR CHOICE IN THE BOX UNDER THE START DATE.

All New Members MUST HAVE an INDUCTION INTO THE GYM, you cannot access the gym until this has occurred!&#13;&#10;Membership covers full 24-hour access to gym facility & all group fitness classes, excluding Pilates Reformer class.&#13;&#10;&#13;&#10;Memberships are under contract for the months you have specified. &#13;&#10;When the contract is up, your door access fob will be suspended & you will receive a notification via text, email or message that your membership contracted time is up & you have the option to renew. &#13;&#10;Full upfront memberships are NON-REFUNDABLE; however, it can be transferred to a friend or family member for the remainder of the contract. You cannot do this without notifying the Gym Manager first, as it needs to be transferred into that person’s name with an induction into the gym.&#13;&#10;If you do not use the gym during the time you have paid for, You DO NOT get your money back, regardless of the reason.&#13;&#10;A 24-hour door access fob is included in the price, any additional door fobs are charged at $25 & are NON-REFUNDABLE upon completion of membership.&#13;&#10;&#13;&#10;

Start Date*

Date

FULL UPFRONT MEMBERSHIP CONTRACTS: Please type your membership preference: 1 Mnth/3 Mnths/6 Mnths/9 Mnths/12 Mnths. CASUAL WEEK PASS *

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

DOB:*

GENDER: M/F

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Emergency Contact Name & Phone Number:*

Are you currently taking any medication?*

YesNoOther

If YES to taking medication, please list medication:

If you answered YES to taking medication, do you require a medical clearance to participate in an exercise program?

YESNONOT SURE

Do you suffer any pain or anxiety while exercising? YES/NO IF YES, Please explain:*

Do you have any previous injuries that may cause you discomfort or pain whilst exercising? YES/NO IF YES, Please explain:*

If yes to previous question, do you have medical clearance to participate in an exercise program?

Have you ever suffered from:

	Please tick
Heart problems
High blood pressure
Diabetes
Epilepsy
Major muscle, joint or back problems
Chest pain
Dizziness or fainting
Arthritis
Hernia
Respiratory problems
Are you pregnant or have you given birth in the last 6 weeks
Other

What are your personal fitness goals?

	Please tick
Reduce body fat/weight loss
Improve muscle tone
Rehabilitation
Improve flexibility
Increase fitness
Build muscle
Stress management
Compete in a fitness competition
Increase body/fat weight
Run a marathon
Other

Are you interested in booking personal training sessions with one of our qualified trainers?

How did you hear about us?

	Please tick
Facebook
Instagram
Google
Website
Friend
Drive by
Other

I declare that the above information I have given is true and accurate to the best of my knowledge and that any injury, condition indicated has been cleared by a medical practitioner for the purpose of exercise.

In the case of injury, condition arising after this date, I will notify Oakey Gym and Fitness Centre in writing immediately.

I hereby certify that I have voluntarily elected to participate in a fitness assessment and are aware of the content and procedure involved.

Please note that 24 hours' notice is required for appointment changes/cancellations or full fees will be applied.

RELEASE OF LIABILITY AND INDEMNITY

FOR AND IN CONSIDERATION, I First Name* Last Name* OF Street Address* City* State* Zip* and all my heirs, successors, executives, administrators, agents and assigns HEREBY AGREE:

TO WAIVE all and any claim, right or cause of action which I or my heirs, successors, executives, administrators, agents, and assigns might otherwise have for or arising out of loss of my life, injury, damage or loss of any description whatsover which I may suffer or sustain in the course of or consequential upon my access and use of the Oakey Gym and Fitness Centre service.
TO RELEASE AND FOREVER DISCHARGE THE Oakey Gym and Fitness Centre, it's officers, employees and agents (RELEASEES) from all liability to me, my personal representatives, heirs and next of kin for loss of my life, injury, damage or loss and any description whatsover arising out of or in any way connected with or incidental to my access or use of the sporting and recreational facilities located at the discretion of Oakey Gym and Fitness Centre whether anticipated or not and whether caused by the negligence, default or misconduct of the Releases or otherwise.
TO INDEMNIFY AND AGREE TO KEEP INDEMNIFIED Oakey Gym and Fitness Centre, it's officers, employees and agents from and against all actions, proceedings, suits, costs, claims, damages, loss, expense and demands or liability of any kind, including all legal costs however or incurred and the costs reasonably incurred in defending or resisting the same, that may be made or brought by any person or persons in respect of personal injury to or the death of any person whomsover or omissions, by reason of my access and use of the Oakey Gym and Fitness Centre service.
I FULLY UNDERSTAND that my access and use of the Oakey Gym and Fitness Centre services may involve the risk of serious injury, including permanent disability, death and social and economic loss arising not only from my own intentional or negligent acts or omissions, but also from the intentional or negligent acts or omissions of others, from the rules of play and their application, from the conditions of the premises and/or equipment, as well as from the other sources both known and unknown.
I ACKNOWLEDGE that prior to being given approval to access and use of the Oakey Gym and Fitness Centre service, that I have received a tour of the facility and the first aid facilities. I acknowledge that I have been given a tour of the proposed training activities and I am satisfied that I fully understand the contents of, the location of, and the safe use of and the working of all things briefed on.
I ACKNOWLEDGE AND UNDERSTAND that I have read and understand the matters set out in this document above and that I am legally competent to give this waiver, release and indemnity. I acknowledge that the conditions set out in this document and contractual in nature, are intended to have legal effect and are not merely a warning or recital. I have signed the document on my own free will and without any representation or inducement by the Oakey Gym and Fitness Centre, it's officers, employees and agents.

Signature*