Lakes Entrance In Balance Fitness Casual Entry

In Balance Fitness Lakes Entrance- casual entry.

Please be at the front door to gain access when completing this form.
Full name*

First NameLast Name
Email*
example@example.com
Date of Birth*

DayMonthYear
Date
Phone Number*
Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

ENTRY CONDITIONS

Please read and check each of the following conditions.
For security purposes, In Balance Fitness uses video surveillance equipment to monitor the club - 24 hours/7 days. By signing this Agreement you acknowledge that you will be subject to video and audio surveillance and recording. Video surveillance is limited to the floor area only, and is not within the walls of the bathrooms or assessment rooms.*

Acknowledged.
If you cause damage to the club or any equipment you are liable to In Balance Fitness for its cost of repair or replacement **

Acknowledged.
In Balance Fitness reserves the right to terminate the passes of anyone who allows access to any additional person with their casual access. A breach of these conditions will incur a $150 fine*

Acknowledged.
Any charges associated with pressing duress buttons –for any reason, other than an emergency will be covered by myself*

Acknowledged.

Declaration:

1. This agreement is legally binding for all types of payments.
2. I acknowledge that In-Balance Fitness is not liable for any personal injury or loss of property.
3. I declare that I am physically and mentally fit for exercise and will inform instructors of any changes.
4. No smoking or chewing gum inside the premises.
5. Correct training attire must be worn; no jeans, work clothes, boots, sandals, or inappropriate clothing.
6. No person under 14 allowed in the gym area without supervision or authorisation.
7. All weights and equipment must be returned to their proper place.
8. A sweat towel is required for every visit.
9. The centre is not responsible for lost, stolen, or damaged items or vehicles.
10. In-Balance Fitness reserves the right to refuse entry, suspend or terminate all passes, or request anyone to leave for inappropriate behavior.
11. In-Balance Fitness may close off areas or equipment for maintenance without notice.
12. Centre policies and guidelines may change without notice.
13. No food is allowed in the gym.

I acknowledge that I have read and agreed to the terms above and on this form.
Signature*

Clear

My Products*

Casual SessionPlease call 0422 058 330 and be at the door at Lakes Entrance, to be given access when payment is complete. (you will receive a thank you message with these details upon completion of payment)

$14.95AUD Quantity
Item subtotal:$0.00AUD

Total

$0.00AUD

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
n the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

In Balance Fitness Lakes Entrance- casual entry.

EXERCISE READINESS (Par-Q)

ENTRY CONDITIONS