Membership & Registration Form

Membership & Registration Form

Complete your PAR-Q before your first session
Personal Details
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Emergency Contact
Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Health Screening
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Medical Information
Please list any injuries or medical conditions we should be aware of.
Please list any current medications.
Starting Level
1. New to fitness or returning after a break.2. Active and training regularly.3. High performance, pushing the limits.
Declaration
Health & Medical Declaration
I confirm that the information provided is accurate to the best of my knowledge. I agree to inform my Team 365 of any changes to my health or medical status. I acknowledge that physical activity carries inherent risks, and I participate at my own risk.
YesNo
Media & Promotional Use
I grant permission for Team 365 to capture and use photographs and video footage of me during training sessions for promotional, marketing, and social media purposes. I understand that these images and videos may be used across various platforms and materials without compensation.
YesNo
Signature*
Date*

MonthDayYear
Date
Should be Empty: