EBFC 2025 Registration Form

EBFC 2025 Registration Form
Member Details
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth

DayMonthYear
Age
MaleFemale
Are you of Aboriginal or Torres Strait Islander origin?

AboriginalTorres Strait IslanderBoth Aboriginal and Torres Strait IslanderNo
Type of Membership

OrdinaryAssociate - do not compete or participate in scheduled classes or training sessions

Emergency Contact Information
Emergency Contact 1

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to Member
Emergency Contact 2

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship to Member

Media Consent
I give my unconditional permission for Emerald Boxing & Fitness Club to use my / my child’s photographic/filmed image for the purpose of promoting, publicising and advertising the club.

I doI do not
Signature

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I, the member, agree that I will abide by the rules of the Emerald Boxing & Fitness Club Inc.
Signature

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Date

DayMonthYear
Date
I, the parent/guardian (if the member is under 18), agree that the member and I will abide by the rules of the Emerald Boxing & Fitness Club Inc.
Signature

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Date

DayMonthYear
Date

Waiver and Release of Liability

You should not sign this document unless you have read it and understood it’s terms and conditions. By signing this agreement, you assume all risks and agree to waive your legal rights, including the right to sue.
WARNING OF RISK:

1. The Participant acknowledges that there can be certain risks of injury to them, or third parties associated with their participation in the selected activities carried out at “Emerald Boxing & Fitness Club Inc”.

2. The Participant knows that at “Emerald Boxing & Fitness Club Inc” the staff are not Medical Practitioners.

3. The Participant knows that they should seek medical advice from a Medical Practitioner before participating in selected activities.

4. The Participant is aware that certain medical problems may arise if they undertake and participate in the selected activities without obtaining advice from a Medical Practitioner beforehand.

5. There may be no or inadequate facilities for treatment or transport of the Participant if they are injured.

6. Personal property is solely the responsibility of the owner whilst at “Emerald Boxing & Fitness Club Inc”. No responsibility will be taken.

7. The Participant agrees to participate in the chosen activity at their own risk and responsibility.

8. The Participant agrees that they will abide by the club rules for participation in various activities on the site of “Emerald Boxing & Fitness Club Inc”.

9. I agree that this agreement shall apply to my participation in any and all “Emerald Boxing & Fitness Club Inc” activities and programs. This agreement shall apply to all my future visits to “Emerald Boxing & Fitness Club Inc”.

10. I assume all risk and responsibility of any injury arising from my participation in my selected activities at “Emerald Boxing & Fitness Club Inc”.

11. I also agree that in the event that I am injured or suffer damage, I will bring NO claim, legal or otherwise against “Emerald Boxing & Fitness Club Inc”, its staff or families in respect of that injury or damage.

12. I acknowledge having received a copy of the “Emerald Boxing & Fitness Club Inc” Gym Rules.

13. I acknowledge that I have been informed of the club’s Public Liability Insurance cover through Sportscover Australia - $ 20,000,000 Public and Product Liability and $1,000,000 Professional Indemnity.

14. Before signing this document, I read and understand it and know it affects my legal rights.
Member Participant's Signature

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Date

DayMonthYear
Date
Parent/Guardian's Signature (if the Member is under 18 years of age)

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Date

DayMonthYear
Date

	Yes	No	Details
Are you taking any prescribed medication?
Are you currently carrying an injury?
Have you suffered or do you suffer from back pain?
Do you smoke?
Are you pregnant?
Are you a non-exercising male over 35 or female over 45?
Do you know your blood pressure?
Does anyone in your family have high blood pressure? Are they on medication?
Do you suffer from Asthma?
Do you suffer from Diabetes?
Has anyone in your family under 60 suffered any heart condition or stroke?

EBFC 2025 Registration Form

Member Details

Emergency Contact Information

Media Consent

Waiver and Release of Liability

Lifestyle and Medical Considerations

Annual Registration Fee