RETURN-TO-PERFORMANCE x 1 SESSION — SIGN-UP & AGREEMENT FORM
  • Image field 1

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM

  • $169.99/week | Automatic weekly billing via Square
  • Welcome to VIRTUS Centre. Please complete all sections of this form fully and honestly before proceeding to payment. Submitting this form constitutes a legally binding agreement between you and VIRTUS Centre. Please read all policies carefully before signing.

  • SECTION 1 — PERSONAL DETAILS

  • Date of Birth
     - -
  • Gender
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • SECTION 2 — PRE-EXERCISE HEALTH SCREEN

  • Based on the ESSA Adult Pre-Exercise Screening System (APSS) V2, 2019. Please answer all questions honestly. If you answer YES to any question, you may be required to obtain medical clearance before commencing training. We will contact you directly before your membership is activated.
  • 1. Has a medical practitioner ever told you that you have a heart condition, or have you ever suffered a stroke?
  • 2. Do you ever experience unexplained pain or discomfort in your chest at rest or during physical activity?
  • 3. Do you ever feel faint, dizzy, or lose balance during physical activity?
  • 4. Have you had an asthma attack requiring immediate medical attention in the last 12 months?
  • 5. If you have diabetes (Type 1 or 2), have you had trouble controlling your blood sugar in the last 3 months?
  • 6. Are you pregnant or have you given birth within the last 12 months?
  • 7. Do you have any diagnosed muscle, bone, tendon, ligament or joint problems that could be made worse by exercise?
  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement
  • Image field 25

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM
    $169.99 / week | Automatic weekly billing via Square

  • 8. Do you have any other condition that may require special consideration for you to exercise?
  • Physical Condition Declaration:
    By proceeding with this form, you represent to VIRTUS Centre that to the best of your knowledge:
    • You do not have any physical, medical, or other condition which may be adversely affected by use of the VIRTUS Centre facility or its equipment.
    • It is your responsibility not to use any equipment that may aggravate a medical condition.
    • If you have any health or medical concerns now or or after joining, you must consult your doctor before using the facility.
    • VIRTUS Centre has not provided and cannot provide you with any medical advice.

  • Current Physical Activity Levels:

  • Training days/week
  • Typical intensity

  • SECTION 3 — REHABILITATION & SUPPORT TEAM INFORMATION

  • Injury / Rehabilitation Details

  • Date injury occurred
     - -
  • DD/MM/YYYY
     - -
  • N/A
     - -
  • Which side is affected?
  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement
  • Image field 46

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM

  • $169.99 / week | Automatic weekly billing via Square
  • Current stage of rehabilitation?
  • DD/MM/YYYY
     - -
  • Unknown
     - -

  • Practitioner Details

  • Format: (000) 000-0000.
  • Rehabilitation Permissions
  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement
  • Image field 63

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM

  • $169.99 / week | Automatic weekly billing via Square

  • SECTION 4 — MEMBERSHIP ACKNOWLEDGEMENT

  • Membership Type: 1-on-1 Return-to-Performance Coaching — 1x Session per Week
  • Weekly Investment: $169.99 / week
  • Billing: Automatic weekly payments via Square
  • Session Structure:
    • One 60-minute private coaching session per week
    • Fully individualised rehabilitation programming
    • Higher supervision and coaching support
  • Program Inclusions:
    • Weekly personalised programming via Lumin Sports
    • Rehabilitation testing and monitoring
    • Weekly communication with practitioner network
    • Exclusive shared testing report updated weekly
    • 24/7 gym access
    • Ongoing support outside sessions
  • Start Date:
     - -

  • SECTION 5 — LIABILITY WAIVER & MEDIA CONSENT

  • Risk Warning:
    VIRTUS Centre warns that whilst you are on the premises using the facility and its recreational services, you are at risk of suffering physical harm or personal injury including but not limited to:
    • Soft tissue injuries, joint injuries, broken bones, permanent disability, or death
    • Slipping on wet or uneven flooring
    • Being struck by weights or colliding with equipment or other members
    • Engaging in strenuous exercise or activities beyond your current capability
    • Incorrect use of equipment
  • You acknowledge that any such injury may result not only from your own actions but from the actions, omissions, or negligence of others. These risks are not exhaustive — there are other
  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement
  • Image field 78

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM

  • $169.99/week | Automatic weekly billing via Square
  • unknown or unanticipated risks that may result in injury, illness, or death. You agree that you are participating voluntarily and at your own risk.

  • Liability Waiver:

  • By ticking below, I acknowledge and agree that
    • I am voluntarily participating in activities at VIRTUS Centre.
    • I understand that physical activity and gym use carry inherent risks and I accept full responsibility for any injuries or health issues that may occur.
    • I have disclosed all pre-existing medical conditions or physical limitations in this form and will notify VIRTUS Centre staff of any changes promptly.
    • I release VIRTUS Centre, its owner, coaches, and contractors from any liability for injuries or health complications sustained during or after use of the facility, except where liability cannot be excluded by law.
    • VIRTUS Centre is not responsible for the loss, theft, or damage of personal belongings while on the premises, including vehicles, their contents, or items left within the facility.
    • If I cause damage to VIRTUS Centre or any equipment, I am liable for the cost of repair or replacement.

  • Video Surveillance:

  • For security purposes, VIRTUS Centre uses video surveillance equipment to monitor the facility. By signing this agreement, you acknowledge that by accessing VIRTUS Centre you will be subject to video surveillance and recording. Surveillance is limited to floor areas only and does not extend to bathrooms or private assessment rooms.

  • Media Consent

  • VIRTUS Centre may capture photos and videos during training sessions and general gym use for educational and promotional purposes across platforms including Instagram, TikTok, and YouTube. Content may include group settings and will not include your name unless agreed separately.
  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement
  • Image field 92

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM
    $169.99/week | Automatic weekly billing via Square

  • SECTION 6 — PAYMENT TERMS & FAILED PAYMENTS

  • By signing this agreement, you agree to the following payment terms:

    • All membership fees must be paid before services are delivered.
    • Weekly payments are processed automatically via Square from your nominated billing account.
    • It is your responsibility to ensure sufficient cleared funds are available on each billing date.

  • Failed / Dishonoured Payments:

    • In the event that a weekly payment is dishonoured, a failed payment fee of $5.50 will apply.
    • Any additional bank charges incurred because of a failed payment are your responsibility.
    • VIRTUS Centre will endeavour to contact you by phone, SMS, or email to notify you of any overdue payment.
    • Repeated failures to meet payment obligations may result in membership suspension or termination by written notice.
    • Any outstanding amounts remain immediately due and payable upon termination.

  • Fee Changes:

    • VIRTUS Centre reserves the right to change membership fees at any time. You will be provided with a minimum of 30 days written notice before any fee changes take effect.

  • SECTION 7 — COOLING OFF PERIOD

  • All new VIRTUS Centre memberships are subject to a 48-hour cooling off period beginning from the date you enter into this agreement.

    • A request to cancel within the cooling off period must be submitted in writing to VIRTUS Centre before the 48-hour period expires.
    • If cancelled within the cooling off period, VIRTUS Centre will refund all membership fees minus an administration fee of $4.99.
    • Refunds will be processed within 7 days of receiving your written cancellation request.
    • After the 48-hour cooling off period has expired, the standard cancellation policy applies.

  • SECTION 8 — CANCELLATION POLICY

  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement

  • Image field 109

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM

  • $169.99/week | Automatic weekly billing via Square

  • Cancellation of Membership by Member:

    • To cancel your ongoing 1-on-1 Coaching agreement, a minimum of 14 days written notice is required via email to VIRTUS Centre.
    • Your account must be in good standing — all fees paid and up to date — to be eligible for cancellation.
    • VIRTUS Centre does not offer refunds on sessions already delivered.
    • Any payments processed within the 14-day notice period are non-refundable.
    • Termination for medical reasons must be accompanied by a medical certificate.
    • In the event of death, the member's estate must provide a death certificate and any unused pre-paid sessions will be refunded.

  • Session Cancellation & No-Show Policy:

  • Your coach dedicates a specific time slot exclusively to you each week.
    The following policy applies to individual session cancellations:
    • 12+ hours' notice — Session cancelled at no charge.
      Rescheduling at your coach's discretion based on availability.
    • 3-12 hours' notice — 30% of your agreed session fee will be charged, unless you can immediately rebook to another available time slot within the same week.
      Your coach will advise availability.
    • Less than 3 hours' notice OR no show — 100% of your agreed session fee will be charged.
      No exceptions. At this point your coach has already prepared and held that time exclusively for you.
  • ▲ Repeated late cancellations or no-shows may result in termination of your
    1-on-1 Coaching agreement at VIRTUS Centre's discretion.

  • Termination by VIRTUS Centre:

  • VIRTUS Centre reserves the right to terminate your agreement at any time if you:
    • Fail to make any agreed payment
    • Breach any part of this agreement, gym rules, or VIRTUS Centre policies
    • Engage in conduct that is improper, unsafe, or harmful to others
    • Are suspected of engaging in illegal activity on the premises
  • Termination will be effective from the date written notice is issued. You are liable
    for all financial obligations up to and including the termination date.
  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement
  • Image field 124

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM
    $169.99/week | Automatic weekly billing via Square

  • SECTION 9 — MEMBERSHIP PAUSE POLICY

  • Members may request to pause their 1-on-1 Coaching membership under the following conditions:

    • Pause requests must be submitted in writing via email to VIRTUS Centre.
    • To be eligible for a pause, your account must be in good standing with all fees paid and up to date at the time of the request.
    • During a membership pause, a reduced holding fee of $19.99/week will be charged to your nominated billing account in place of your standard weekly fee. (This is $5.00 less than our standard holding fee — a thank you for your commitment and major support of VIRTUS Centre.)
    • This holding fee retains your dedicated session time slot and coach relationship.
    • The maximum pause period is 3 months.
    • Your standard weekly membership fee of $149.99/week will resume automatically at the end of your nominated pause period.
    • If you wish to return before your nominated pause end date, please notify VIRTUS Centre in writing and your sessions will be reinstated promptly.

  • ▲ The $19.99/week holding fee applies from day one of any pause period.
    Failure to pay the holding fee may result in loss of your session time slot.

  • SECTION 10 — GYM ACCESS & SAFETY POLICY

  • Facility Access:

    • Your membership is non-transferable. Only the member named in this agreement may access VIRTUS Centre using their membership credentials.
    • No member is permitted to bring a non-member into the facility or allow another person entry without using the correct procedure. Breach of this clause may result in a fee and/or membership termination.
    • Outside of staffed hours, members are responsible for securing the facility as instructed during induction. This includes closing and locking all doors and turning off all lights.

  • Safe Training:

    • Notify VIRTUS Centre staff of any pain, illness, or injury before using the facility.
    • Use all gym equipment responsibly and within your current physical capability.
    • Do not use equipment marked as out of order or restricted during unstaffed hours.
    • Return all equipment to its correct position and wipe down after use.
    • Misuse of equipment may result in a damage fee or restricted access.

  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement

  • Image field 135

  • RETURN-TO-PERFORMANCE X 1 SESSION — SIGN-UP & AGREEMENT FORM

  • $169.99 / week | Automatic weekly billing via Square

  • Conduct:

    • VIRTUS Centre is an inclusive community. Discrimination, harassment, bullying, intimidation, offensive behaviour, or any conduct that makes others feel unsafe will NOT be tolerated and may result in immediate membership termination.
    • Follow all safety signage and instructions from VIRTUS Centre staff at all times.
    • VIRTUS Centre reserves the right to restrict your membership to staffed hours only if there is concern for your health, safety, or conduct.

  • SECTION 11 — DIGITAL SIGNATURE & DECLARATION

  • By completing this section and submitting this form, you confirm that all information provided is truthful and accurate, and that you have read, understood, and agreed to all VIRTUS Centre policies, waivers, and terms contained in this agreement Your typed full name below serves as your legally binding digital signature.
  • For any questions about this agreement please contact VIRTUS Centre before submitting. By submitting this form, you confirm all policies are binding from the date of your first payment.
  • Today's Date
     - -
  • VIRTUS Centre | seb@virtuscentre.com.au | info@virtuscentre.com.au | Confidential Member Agreement
  •  
  • Should be Empty: