Gym Disclaimer

Gym Disclaimer

DAY PASS ONLY
Full name

First NameLast Name
Birth Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Emergency contact

First NameLast Name
Phone number
Clients information - Health questionnaire
In order to enjoy the Gym to its full potential and to ensure your safety, certain precautions need to be taken. Please note that if you do not complete this form, you will be refused entry to the Gym.

PLEASE NOTE THIS PASS IS NOT A 24- HOUR PASS TO USE G.V. FITNESS CENTRE'S FACILITIES.

All participants must be 16+ years of age to use facilities.

READ THE FOLLOWING CAREFULLY AND COMPLETE AND SIGN
Users are advised not to undertake physical activity for which they might be medically unfit.

G.V. Fitness Centre and C.A.R.E. Herefordshire CIC will not be in any way responsible for any harm which may come to the user as a result of their undertaking any activity within the Gym facilities which is beyond their physical capability.

Please ensure that if you suffer an injury within the facilities that you report it immediately to a member of staff within G.V. Fitness Centre, G.V. Cafe or Pontrilas Store and Post Office.

You should not use the Gym if you have eaten or had any alcohol within 90 minutes of taking exercise.Please indicate below if you have previously suffered from the following:

PAR-Q

	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 fain in your chest when you do physical activity?
In 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?

Initials

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Please ensure that you follow the guidance information below:

a. I will follow the operating instructions found on the equipment.
b. I understand it is my responsibility to familiarise myself with the location of all
marked emergency alarms within the Gym which will notify a member on duty at
reception.
c. If I raise the Panic Alarm then I will:

Remain in the Gym until professional assistance arrives.
If I raise the Fire Alarm then I will:
Follow all emergency exit routes and evacuate the building congregating
in Pontrilas Business Park carpark.

I HAVE READ AND UNDERSTAND THE INFORMATION ABOVE AND TAKE
FULL RESPONSIBILITY FOR MY ACTIONS WHILE WITHIN THE GYM AREA.
Liability waiver
I am aware of the risks in observing or participating in the facility offered and sponsored by G.V. Fitness Centre and I understand that all exercise I will execute and participate in are entirely at my own risk and perils.

I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of these risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement.

I realize that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I sustain, including personal injuries to me, damage to my property, or damage arising out of my death. It is understood that G.V. Fitness Centre is responsible for any damage that would be resulting from a fault of equipment and its representatives.
Initials

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Gym Disclaimer

Clients information - Health questionnaire

Liability waiver