MĀTĀTOA GYM APPLICATION, HEALTH & SAFETY INDUCTION, DECLARATION AND CONSENT FOR USE

MĀTĀTOA GYM APPLICATION, HEALTH & SAFETY INDUCTION, DECLARATION AND CONSENT FOR USE
Applicant's Name*

First NameLast Name
Student ID
Programme
Phone Number
Please enter a valid phone number
Email
example@example.com
Category

StaffStudent
APPLICANT'S DECLARATION

I, the above name undertake that I:
- Will not perform any potentially dangerous exercises or movements that could cause injury to me or others within Mātātoa Gym.
- Have received appropriate information on how to safely use the gym equipment.
- Will not access Mātātoa Gym if I am under the influence of any drugs or alcohol.
- Will only access Mātātoa Gym with my own WITT ID card and will not allow access to any other person. This includes non-members, visitors, family and children that do not have their own WITT ID card.
- Will not enter any designated “no entry” areas.
- Will supply my own towel and wipe down all equipment with paper towels and the sanitiser supplied after use.
- If WITT Management feels that I have abused the access system or breached Mātātoa Gym rules or the WITT Code of Conduct in any way then they can cancel my membership without a refund of subscription.
- Am over 16 years of age.
- Am aware that CCTV will be in operation at all times and video footage will be viewed if there is an incident reported.
I declare that:
- I have received health and safety induction training.
- I accept that having access to Mātātoa Gym and adjoining changing rooms will mean that I am fully responsible for my actions within these areas.
Applicant’s Signature

Clear
Date*

DayMonthYear
Date
MEMBERSHIP INFORMATION

STAFF & STUDENTS - Free after completing this Health and Safety Induction form

ACCESS HOURS 5:00am - 8:00pm Daily

OPENING HOURS 5:00am - 9:00pm Daily

From time to time access may be limited due to teaching commitments or equipment maintenance - refer to the Mātātoa Gym timetable for more information.
MĀTĀTOA GYM APPLICAITON, HEALTH & SAFETY INDUCTION, DECLARATION AND CONSENT FOR USE

Applicants are to book health and safety induction training by contacting one of the qualified gym instructors as follows:
- Kieran McKendry k.mckendry@witt.ac.nz
- Kieran Vooght k.vooght@witt.ac.nz
- Josh Lowl j.lowl@witt.ac.nz
OFFICE USE ONLY

To be completed in person by qualified gym instructor
The WITT qualified gym instructor will complete the following record of health and safety induction for each of the members prior to the commencement of access to the gym. Please tick () when complete

First-aid kit location and proceduresEmergency evacuation proceduresUse of bathroom, toilets and changing facilitiesSmoking/vaping policyHygiene requirements for equipmentClothing and footwear requirementsLocation of the defibrillatorAfter hours contact information – displayed in the gymIncident reporting procedures – location of formHow to report faulty or damage equipment
Applicant's Name

First NameLast Name
Applicant's Signature
Instructor's Name

First NameLast Name
Instructor’s Signature
Should be Empty:

MĀTĀTOA GYM APPLICATION, HEALTH & SAFETY INDUCTION, DECLARATION AND CONSENT FOR USE

OFFICE USE ONLY