General Membership Form Step 1 of 2 – Personal Information 0% Please fill in the form below prior to visiting the gym. If you have already filled the form in and are signing up by direct debit please click the button below. Direct Debit Sign Up First Name(s)(Required) Surname(Required) Sex(Required) Male Female Date of Birth(Required)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Mobile/Telephone(Required)Email(Required) Address(Required) Street Address Town Postcode In the event of an emergency, contact:Name(Required) First Mobile/Telephone(Required) Physical Activity Readiness QuestionnaireHas your doctor ever said that you have a heart condition?(Required) Yes No Has he/she recommended that you only participate in specific activities? Yes No Is there a history of heart disease in your closest family (below age of 55)?(Required) Yes No Do you have chest pain brought on by physical activity?(Required) Yes No Have you developed any other chest pain in the past?(Required) Yes No Do you ever lose consciousness, become dizzy and/or lose your balance?(Required) Yes No Do you have a bone or joint problem that could be aggravated by exercise?(Required) Yes No Do you have any other injuries or medical conditions?(Required) Yes No Are you currently on any medication?(Required) Yes No Are you pregnant or have you given birth within the last ten weeks?(Required) Yes No Are you aware through your own experience or a doctor’s advice, of any other reason why you should not exercise without medical approval?(Required) Yes No If you answered YES to any of the questions above, please use the box below to provide details and state the relevant question number.Additional InformationPhysical Activity Readiness Questionnaire A doctor’s certificate/note may be required prior to training if 1 or more ‘yes’ answers were given to the above questions. If you have a temporary illness (eg. flu, fever, feeling unwell), we ask that you do not attend the gym and risk passing these illnesses to others. The information provided is confidential and will not be released or revealed without your written consent. I have read and fully understood the questions asked of me and confirm that the answers I have given are correct to the best of my knowledge. In signing this form, I understand that I carry full responsibility for myself in engaging in physical exercise and will adhere to all government guidelines regarding Covid-19. Gym Rules I hereby acknowledge that the information provided above is correct to the best of my knowledge and should any details change, it is my responsibility to inform a member of staff as soon as possible. I have completed a Physical Activity Readiness Questionnaire (PARQ) form above and either booked an induction or completed the gym induction waiver declaration. I hereby agree to abide by the gym policies and accept that memberships are non-refundable with no exceptions. The gym reserves the right to refuse entry to the facility at any time, for any justifiable reason. All members are expected to wear sports clothing at all times while training inside the gym. Including footwear. I accept that when using any the changing rooms, I am doing so entirely at my own risk and that Royals Gym cannot be held responsible for any damage and/or theft of personal belongings. I understand that any serious or continued breach of these rules may result in the termination of membership. Please note, even in the event of this form being read and signed by a parent/guardian for the teen active membership, Gym Rules apply to all gym members including dependants WAIVER OF LIABILITY FOR GYM USE I/We hereby understand and acknowledge that the training, programs and events held by Royals Gym may expose me to many inherent risks, including accidents, injury, illness, or even death. I/We assume all risk of injuries associated with participation including, but not limited to, falls, contact with other participants, the effects of the weather, including high heat and/or humidity, and all other such risks being known and appreciated by me. I/We hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with participation in activity. I/We acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in. After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and Royals Gym furnishing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD HARMLESS, WAIVE AND RELEASE Royals Gym, its officers, agents, employees, organisers, representatives, and successors from any responsibility, liabilities, demands, or claims of any kind arising out of my participation in Royals Gyms training, programs and/or events. By my signature I/We indicate that I/We have read and understand this Waiver of Liability. I am aware that this is a waiver and a release of liability, and I voluntarily agree to its terms. Terms and Conditions(Required) I agree to the terms and conditions aboveSignature(Required)
