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BODY ACTIVE GYM

Membership Application Form

SECTION 1: PERSONAL DETAILS
IN CASE OF EMERGENCY CONTACT
MEMBERSHIP DETAILS
PERSONAL MEDICAL DETAILS AND INFORMATION

MEDICAL HISTORY - DO YOU HAVE OR HAVE YOU HAD IN THE PAST?

Condition Y N
A history of heart problems, chest pains or stroke.
A family history of heart problems, chest pains, or stroke.
Increased blood pressure.
Any chronic illness or condition.
Orders from your doctor NOT to exercise.
Any surgery in the last twelve (12) months.
Pregnancy (now or in the last three (3) months).
History of breathing or lung problems, e.g. asthma / emphysema.
Any injury of / or muscle joint or back disorder still affecting you.
Arthritis, rheumatism, gout.
Diabetes or Thyroid problems.
Do you smoke?
Obesity (more than 20% over ideal body weight).
Increased cholesterol.
Hernia or any other condition that may be aggravated by lifting weights.
Are you allergic to any medication?
Do you have any allergies?
Are you on medication? If so for what?

The BODY ACTIVE GYM Team welcomes you. Please feel free to approach any member of the team at any time to ask for advice, criticize, complain, praise etc: We are here to ensure your exercising is done in a pleasant and safe atmosphere.

Many Thanks,
BODY ACTIVE GYM Management.
TERMS AND CONDITIONS OF MEMBERSHIP
  • All members pay a nominal joining fee.
  • Corporate clients are members who join as an entity and will have a minimum of 10 members and above.
  • Fees must be paid on or before the due date.
  • All students are to produce a valid and current student card (ages 21 and below).
  • PLEASE NOTE: Membership monies are NOT REFUNDABLE. Credits will be given in cases of illness and/or injuries where exercise is forbidden. A physician's letter is required. Prior notification in writing is also required, if going away for periods exceeding 2 weeks.
  • All members entering the gym are required to have their sweat towels with them at all times and closed tackies - compulsory.
  • The Right of Admission is Reserved.
  • Membership to BODY ACTIVE GYM is not transferable to anyone.
WAIVER

I, acknowledge that I am aware of the possible risks in my taking part in an exercise programme and do not hold BODY ACTIVE GYM responsible in the event of any loss or injury.

I declare to be in good health and free from any physical condition, which might render dangerous my attendance at BODY ACTIVE GYM, save for any condition, which I record in writing on the medical History Questionnaire at the time of admission.

BODY ACTIVE GYM reserves the right to cancel the membership of any person who does not adhere to the safety precautions, medical advice and instruction as given by the staff.