H A W A I K I Functional Fitness - Membership/Registration Form

MEMBERSHIP/REGISTRATION FORM
PERSONAL DETAILS
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Date of Birth

DayMonthYear
EMERGENCY CONTACT
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
INJURIES
Do you have or have had any major injuries in the following areas?(Please provide one of our Trainers with details of any other injuries, conditions or concerns e.g. Breastfeeding, Asthma or breathing difficulties, abnormal blood pressure.)

Other
If "Other", please specify:
MEMBERSHIP OPTIONS

Please select one of the membership options below:
H A W A I K I - Usual Membership options
"PUNA ORA" - Kaumātua/Kuia Class - Free Every Tuesday 11am

"Pīpī Paopao" Nakawhiti reo māori, 5-8year olds, every Tuesday 3.30pm - 4pm, term-time only, $60 per term

Casual/Drop-In Rate:

$15per class
Membership Cancellation Policy:

We allow membership to be placed on hold two times per year for a minimum duration of one week and can not be longer than one month.

A minimum of 3 days notice (via email only) is required for cancellations. Current rates apply when re-joining.
PAYMENT DETAILS

Set up an Automatic payment - choose your option below
Payment frequency
Membership payments must be made and received the week/fortnight/month prior (in advance) in order to maintain your membership and capability to book-in and attend classes.

Payments to:

ASB

HAWAIKI

12-3097-0015500-00

Please use your name and membership option as references e.g

Particular: *Your name* Code: Hawaiki Reference: Unlmtd
We are in the process of setting up an automatic direct debit option which is not available at the moment
TRAINING WAIVER

Please select that you understand and agree to the following
I have joined Hawaiki, and understand this involves physically challenging activities, including but not limited to, weight training, cardiovascular exercise, stretching, physical conditioning and do not suffer from any disability that would prevent or limit my participation in this exercise program. In consideration of my participation at Hawaiki under the program designed/ or run by Hawaiki trainers and staff, I for myself, my heirs and assigns, hereby release Hawaiki from any claims, demands, and causes of action arising from my participation in this exercise program
POTENTIAL RISKS

Please select that you understand and agree to the following:
There exists a possibility that certain physiological changes may occur during or following exercise which can not always be predicted. These abnormal reactions include: Blood pressure, Heart rate, Ineffective functioning of the heart, In rare circumstances - heart attack or stroke.
That I may injure myself as a result of participating in physical activity at Hawaiki. I hereby release Hawaiki from any liability now or in the future, including those but not limited to those conditions listed above, heart attacks, muscle strains, pulls or tears, broken bones, shin splints, knee/lower back/foot injuries, and any other illness, soreness or injury, however caused, occurring during or after my participating in physical activity at Hawaiki.
WEBSITE/SOCIAL MEDIA CONTENT

Please select that you understand and agree to the following:
I give Hawaiki and the events owned by these companies consent to use my name and images on their websites, Facebook/Instagram pages and advertising promotional material.
Signature
If under 18 years of age, Parent/Caregiver must sign:
Parent/Caregiver Name

First NameLast Name
Should be Empty:

MEMBERSHIP/REGISTRATION FORM

PERSONAL DETAILS

EMERGENCY CONTACT

INJURIES

MEMBERSHIP OPTIONS

PAYMENT DETAILS

TRAINING WAIVER

POTENTIAL RISKS

WEBSITE/SOCIAL MEDIA CONTENT