Membership Sign up
Personal details
Name
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First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
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D.O.B
*
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Day
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Month
Year
Date
Gender
*
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Address
*
Street Address
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Emergency contact
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Format: (000) 000-0000.
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Under 18 - Guardian information
If you are over the age of 18 please skip this page
Name
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Relationship
Email
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Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Guardians signature
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Membership selection
Direct debit payments are taken out on a fortnightly basis. Please note there is a $50 tag fee that is to be paid on your day of sign up or you can add it to your direct debit. 2 weeks notice is requires when cancelling (no-contract plan or out-of-contract term)
Membership Options
*
I am aware that the Joining Fee ($50) will be added to my first direct debit:
*
Add to my first direct debit
I'm under 16y of age - no joining fee (including 24/7 key) applicable
Key Fob Number
Notes:
Anything you would like us to know
Name of Bank
*
Name on Account
*
BSB
*
Account number
*
Signature
*
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Health Questionnaire
Do you suffer from any of the following
*
Heart condition
Epilepsy
High cholesterol
Asthma
Liver Kidney
Liver kidney conditions
Diabetes
Hernia
Pain or tightness in chest
None of the above
Other conditions we should be aware of
If you selected yes to any of the above conditions, has your doctor given you clearance to exercise?
Please Select
Yes
No
Other
I am confident to use all the equipment at DRIVEN Athletica without assistance.
*
Yes
No (I will ask staff for help)
Would you like one of our personal trainers to contact you?
*
Please Select
Yes
No
I will get in contact when i'm ready
WAIVER OF LIABILITY
*
I understand that participation in physical activities may expose me to certain risks, and I do so at my own risk. I will not hold DRIVEN Athletica, its staff, or contractors liable for any injury, loss, damage, or death caused to me or my property, whether by negligence, omission, breach of contract, or otherwise.
MEDICAL DECLARATION
*
If my medical status changes during my membership, I will complete a new pre-activity questionnaire. I understand it is my responsibility to inform the club of any medical or physical conditions that may prevent me from exercising. I acknowledge that I participate in exercise at my own risk.
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