Gym Registration Form

R Fitness Notre Dame Registration Form

Join our gym and start your fitness journey today! Please fill out the form to register.
Please select one:*

New MembershipMembership Renewal
Personal Information
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Gender

MaleFemaleOther
Address*

Street Address

Street Address Line 2

City / Province

Postal Code
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Relationship
Emergency Contact Phone Number*
Please enter a valid phone number.
Medical Information
Do you have any medical conditions or allergies?

YesNo
If yes, please provide details
Membership Information

Members under 15 years old must be accompanied by an adult.

PLANS	3-Months (taxes not incl.)	Annual - get one month FREE (taxes not incl.)
Individual	$150	$550
Buddy Plan (incl. two memberships)	$270	$990
Family Plan (includes anyone under the same household)	$420	$1540
55+/student Plan	$120	$440
Day pass - $15

Choose Membership Type*

IndividualBuddy PlanFamily Plan55+/Student PlanDay Pass*Corporate
*Corporate membership rate requires proof of current employment (e.g., employee ID, recent pay stub, or company letter) and apply to annual memberships only.
Company Name*
Choose Membership Duration*

3-MonthsAnnual
Total membership cost + $20 refundable* access card deposit
*$20 is refunded when access card is returned in good standing.
Total renewal membership cost
Total Corporate membership cost
Total Day Pass Cost
Buddy's Name (this individual will need to complete their own registration form)

First NameLast Name
Please list all household members to be included in the plan.
Note: Each individual listed above will need to complete their own registration form.
Preferred Start Date

MonthDayYear
Date
Gym Waiver

In consideration of being allowed to participate in the Activity and other good and valuable consideration, the receipt of which is hereby acknowledged, I (the “Participant”) agree with R Fitness Notre Dame of 182 Notre Dame Ave, Notre Dame de Lourdes, MB R0G 1M0, Canada (the “Provider”) to the following:
- I contract on behalf of myself, my heirs, executors, administrators, successors and assigns, that the Provider and its insurers, employees, officers, directors, and associates, shall not be liable for any damages arising from personal injuries (including death) sustained by me, on, or about the premises, or as a result of the use of the equipment or facilities, regardless of whether such injuries result, in whole or in part, from the negligence of the company.
- I assume full responsibility for any and all injuries, damages (both economic and non-economic), and losses of any type, which may occur to me, and I hereby fully and forever release discharge the Provider, its insurers, employees, officers, directors, and associates, from any and all claims, demands, damages, rights to action, or causes of action, present of future, whether the same be known or unknown, anticipated, or unanticipated, resulting from or arising out the use of said equipment and facility.
- I understand I am solely responsible for safety and wellbeing of myself. I understand that the company does not provide supervision, instruction, or assistance for the use of the facility and equipment.
- I understand and comply with all rules imposed by the Provider regarding the use of the facility and equipment. I conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment in a manner inconsistent with its intended design and purpose.
- I understand and acknowledge that the use of exercise equipment involve risk of serious injury, including permanent disability and death.
- I understand that the Provider is not responsible for property that is lost, stolen, or damaged while in, on, or about the premise.
- I agree to abide by the Terms & Conditions of the Provider.
- I RELEASE OF LIABILITY AND VOLUNTARILY EXECUTED THIS DOCUMENT WITH FULL KNOWLEDGE OF ITS CONTENT.
For Participants Under 18 Years of Age
As the parent/legal guardian of First Name Last Name , I First Name Last Name confirm the health declaration and agree to the waiver of liability on their behalf.
Payment Options

An invoice will be sent to the email you provided above.

ETRANSFER: rfitnessnotredame@gmail.com
CHEQUE: made out to R Fitness Notre Dame
TERMS & CONDITIONS: payment is due upon receipt
Should be Empty:

R Fitness Notre Dame Registration Form

Personal Information

Emergency Contact Information

Medical Information

Membership Information

Gym Waiver

For Participants Under 18 Years of Age

Payment Options