Membership Details

Student Workout Flexi 16-17 years Membership Application

This membership is for students aged 16-17 years and has a 4 week minimum term.
Membership Start Date*

DayMonthYear
Start date must be within the next 30 days.
Member Name*

First NameLast Name
Date of Birth *

DayMonthYear
Age Calculation
This membership is for students aged 16-17 years.
Email*
example@example.com
Gender*

MaleFemaleOther
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone number*

Additional Information
Parent/Guardian Name*

First NameLast Name
Date of Birth (Parent/Guardian)*

DayMonthYear
Relationship of Parent/Guardian*
Parent/Guardian Email*
example@example.com
Parent/Guardian Primary Phone Number*
Parent/Guardian Secondary Phone Number

Member Acknowledgement and Agreement
I acknowledge that I have completed the pre-exercise screening questionnaire below and meet the criteria to proceed with membership*

YesNo
You need to agree to this in order to proceed
I Agree. By selecting 'Yes' and clicking the 'Next' button you acknowledge that you have completed the pre-exercise screening questionnaire/tool below and meet the criteria to proceed with your membership.

This pre-exercise screening tool does not provide advice on any matter nor does it substitute for advice from an appropriately qualified medical professional. M.A. & C.B. Burke Pty. Ltd. (ACN 010 510 988) t/as Workout Indooroopilly (“Workout Indooroopilly”) gives no warranty of safety resulting from its use. The use of this pre exercise screening tool in no way guarantees or safeguards against any injury or death sustained as a consequence of undertaking activities in our facilities. No responsibility or liability whatsoever can be accepted by Workout Indooroopilly for any loss, damage, illness, injury or death that may arise from any person acting on any statement or information contained in this document.

Please read the questions below:
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
7. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?
IF YOU ANSWERED ‘YES’ to any of the 7 questions, please seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/exercise.

IF YOU ANSWERED ‘YES’ to any of the 7 questions and you proceed with your membership, you acknowledge that you are currently under the supervision of a medical practitioner who has approved your participation in an exercise program, and meet the criteria to proceed.

IF YOU ANSWERED ‘NO’ to all of the 7 questions, and you have no other concerns about your health, you meet the criteria to proceed with your membership and may proceed to undertake light-moderate intensity physical activity/exercise.

Undertaking any form of physical activity or exercise has inherent risks, including physical injury and death, and you should carefully consider whether you are fit and able to undertake those activities before doing so. You are responsible for your own health and where you are uncertain as to your fitness and capability to undertake those activities you need to obtain proper advice and instruction before doing so. If you proceed to undertake those activities at Workout Indooroopilly without obtaining such advice you do so at your own risk.
Informed Consent by Parent/Guardian
By ticking "I Agree" below and clicking the "Next" button you acknowledge and agree that:

(a) You believe that to the best of my knowledge, all of the information you have supplied within this questionnaire regarding your child’s health is true and correct;

(b) You understand that Workout Indooroopilly may rely on the information that you have provided in this form;

(c) You also agree that should the information about your child’s fitness or health contained in this form change, it is your responsibility to notify Workout Indooroopilly in writing of this change and to obtain a clearance or additional clearance from any medical professional or to understand any limitations or restrictions your child may be subject to before your child undertakes any exercise or activity at Workout Indooroopilly;

(d) You give permission for your child to commence exercise and activity at Workout Indooroopilly.
I agree
Date*

DayMonthYear
Date

Student Workout Flexi 16-17 years Membership Details
Member name: {memberName}

Minimum Term: 4 weeks

Membership Term: Ongoing

Membership Start Date: {membershipStart}

Membership Fees (Per fortnight): $90.00

First Direct Debit: To be confirmed

A Pro-Rata membership amount for the period from your membership start date ({membershipStart}) to the first direct debit date will be calculated and added to your first direct debit.

Billed Today: $0

Future Direct Debit Payments will be debited to your bank account or credit card. We will contact you shortly to confirm these details.
Member Acknowledgement and Agreement
By ticking "I Agree" below and clicking the "Confirm Purchase" button you acknowledge and agree that:

(a) You have read, understand and agree to the Workout Indooroopilly Membership Terms & Conditions, Direct Debit Terms & Conditions and the Privacy Policy (located on our website at www.workout.net.au);

(b) The information you have provided to Workout Indooroopilly is true and correct;

(c) You understand that you are signing up for a membership contract that requires among other things payment of membership fees;

(d) Prior to commencing any activities at Workout Indooroopilly you must complete a pre-exercise screening questionnaire and meet the criteria to proceed with your membership;

(e) Every time you use the Workout Indooroopilly facilities you will be in good physical condition and know of no medical or other reason why you cannot or should not do active or passive exercise;

(f) Your Workout Membership is an on-going membership unless an end date is specified.

Please read our Privacy Policy to understand how we collect, store and use your personal information. Our current Privacy Policy, Membership Terms & Conditions and Direct Debit Terms & Conditions can be located on our website at www.workout.net.au/policies-and-legal. You may also contact us at any time with any queries or concerns at hello@workout.net.au.
I agree
Date*

DayMonthYear
Parent/Guardian Acknowledgement and Agreement
By ticking "I Agree" below and clicking the "Confirm Purchase" button you acknowledge and agree that:

I {name16} being the parent or guardian of the member {memberName}, confirm that I have received, understood and agreed to the Workout Indooroopilly Membership Terms & Conditions, Direct Debit Terms & Conditions, and Privacy Policy and where the context permits, those will apply myself as if I too were a member of Workout Indooroopilly. By signing this application form I have agreed to indemnify Workout Indooroopilly against any claim or liability, of whatever nature, that I may bring or may be brought against Workout Indooroopilly, regarding or in connection with the member {memberName} while the member remains under the age of 18 years.
I agree
Date*

DayMonthYear
Date
M.A. & C.B. Burke Pty. Ltd. (ACN 010 510 988) t/as Workout Indooroopilly
138 Witton Road, Indooroopilly QLD 4068
P: 07 3378 8950 E: hello@workout.net.au
Should be Empty:

Student Workout Flexi 16-17 years Membership Application

Additional Information

Member Acknowledgement and Agreement

Informed Consent by Parent/Guardian

Student Workout Flexi 16-17 years Membership Details

Member Acknowledgement and Agreement

Parent/Guardian Acknowledgement and Agreement