UMA Gym: New Member & Guest Form

New Member & Guest Form

UMA Gym
True strength is never made on your couch; it’s made in the gym.

Come see our space, try the equipment, and feel the Brotherhood vibe!

🗓️ 1 Week FREE Trial
💰 Just $40/month
🕑 Open 5 AM - 11 PM
Name*

First NameLast Name
Date of Birth: *

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Name*
Emergency Number*
Address*
Pre exercise questionnaire*

Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?Do you ever experience unexplained pains or discomfort in ytour chest at rest or during physical activity/exercise?Do you ever feel faint, dizzy or lose balance during physical activity/exercise?Have you had an asthma attack requiring immediate medical attention at anytime over the last 12 months?If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?Do you have any other conditions that may require special consideration for you to exercise?NONE OF THE ABOVE HEALTH CONDITIONS APPLY TO MEOther
Personal Training*

Refer me to one of your personal trainers please!I’m interested in a complimentary session only.No thanks!
Preferred method of contact*

Text messageCallEmail
Disclaimer

LIABILITY: According to the Australian Consumer Law (ACL), we guarantee that the services provided are: (i) executed with due care and skill; (ii) reasonably fit for any stated purpose or achievement you've communicated to us; and/or (iii) supplied within a reasonable timeframe. However, specific legislative provisions permit us to request acceptance of limitations to these guarantees. To the extent allowed by s139A of the Competition and Consumer Act 2010 (CCA), you agree to exclude or modify our liability for death or injury resulting from our failure to comply with ACL guarantees. This exclusion doesn't apply in cases of "reckless conduct" as defined in the CCA, leading to your death or injury. In Victoria and South Australia, this exclusion is applicable only with additional documentation. Subject to applicable laws, all implied terms, conditions, warranties, guarantees, rights, or remedies that can be lawfully excluded are hereby excluded.
I acknowledge that the screening system does not provide assurance against injury or fatality. UMA Brotherhood Gym disclaims any responsibility or liability for any loss, damage, or injury that may result from individuals acting upon any statement or information within this system.*

I Agree
Signature*

Clear
Should be Empty: