Three Springs Community Gym Membership Form Logo

  • Please Read throught the Shire of Three Springs Community Gym Code of Conduct and Terms Conditions.

    Please Read throught the Shire of Three Springs Community Gym Code of Conduct and Terms & Conditions.

  • Three Springs Community Gym Membership Form

  • DISCLAIMER: The Shire of Three Springs Community Gym operates on a 24 hours, seven (7) days basis and is accessible by members.  

    The Shire of Three Springs has made every effort to ensure that the Gym Participation Policy has been prepared and implemented to promote the safe and correct use of gym equipment to encourage a safe environment for all gym users.

     You accept and understand that there are obvious and inherent risks in the activities undertaken at the Shire of Three Springs Community Gym and acknowledge that the activities you undertake whilst at the Gym may involve a risk of physical harm and that participating in these activities voluntarily, you do so at your own risk. The Shire of Three Springs, its servants and agents, accept no liability for any loss or damage to property or death or personal injury, however arising from your use of the Shire of Three Springs Community Gym.  All gym users are advised to seek medical consultation and clearance before commencing an exercise program.

    This agreement is subject to a 7-day cooling-off period.

    I acknowledge that I have read and understood the Terms and Conditions contained in this form.  I agree to abide by and to be bound by any special conditions contained within those terms.

  • Applicant Details:

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  • Bond Deposit Refund Creditor

    Address: PO Box 117 Three Springs WA 6519Phone: (08) 9954 1001Email: afo@threesprings.wa.gov.au

  • Bank Details

  • Adult Pre-Exercise Screening Tool

    Please complete the following Adult Pre-Exercise Screening Tool: This screning tool does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualifiedmedical professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury ordeath. No responsibility or liability whatsoever can be accepted by Exercise and Sports Science Australia, Fitness Australia or SportsMedicine Australia for any loss, damage or injury that may arise from any person acting on any statement or information contained in this tool. AIM: to identify those individuals with a known disease, or signs or symptoms of disease, who may be at a higher risk of an adverse event during physical activity/exercise. This stage is self-administered and self evaluated.

  • 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 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.

    Please read through the attached Exercise Intensity Guidelines.

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  • Consent: I confirm that all information provided is true and correct. I consent to the Shire of Three Springs collecting and verifying my personal details and ID documents for the purpose of administering my Community Gym membership, and I agree to abide by the Community Gym Code of Conduct and Terms and Conditions.

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  • Thank you for completing this form. You will receive a copy of this form after you hit submit in your email (if added).

     

    Before Submitting this form:

    Please download the EVVA Airkey App from the following link or app/play store according to your device type before your Phone Call appointment.

    For Android Users: Click Here

    For Iphone Users: Click Here

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