Gym Memberships Membership Form Name: Address: Membership Start Date: Payment Details The cost of the membership is 18.50 per month, plus a one off cost of 5 for the band. This Payment should be made either by cheque (payable to Highdown Sport and Leisure Ltd) or cash. Subsequent payments of 18.50 will be made via Direct Debit. PLEASE NOTE: payments will show on your bank statement as Fitness First. You will be emailed a conformation when set up therefore we must be given your email address. By signing the contract on the next page you are confirming that you have been informed on the following: 1. Location of fire exits closest to the gym 2. Where to report to if the building is evacuated 3. How to raise the alarm in the event of an emergency 4. Accept the rules, terms and conditions laid down by Highdown Sport & Leisure Limited and agree to abide by them
Hours of Opening Fitness Suite Monday 15:30 22:00 Tuesday 15:30 22:00 Wednesday 15:30 22:00 Thursday 15:30 22:00 Friday 15:30 21:00 Saturday 08:00 18:00 Sunday 08:00 18:00 Swimming times Monday 19:30 21.30 Tuesday 20:30 21.30 Wednesday 19:30 21.30 Thursday 19:30 21.30 Friday 19:30 20:30 Saturday 15:00 17:30 (Members) 15:00 17:15 (Public pay as you go) Sunday 12:00-14:00 (Public pay as you go and members)
Highdown Sports & Leisure Ltd (PAR-Q) Name: D O B: Address: Postcode: Email: Mobile: Please tick the box if you are happy for us to contact you via your email If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide when answering these questions. Please read carefully and answer each one honestly: Circle YES or NO. 1. Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? 2. Do you feel pain in your chest when you do physical activity? 3. In the past month, have you had a chest pain when you were not doing physical activity? 4. Do you lose your balance because of dizziness or do you ever lose consciousness? 5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity? 6. Is your doctor currently prescribing medication for your blood pressure or heart condition? 7. Do you know of any other reason why you should not do physical activity? 8. Do you have a family history of heart disease, hypertension, stroke, diabetes, heart failure, lung disease or epilepsy? If yes, please comment: Emergency Contact Name: Phone Number: Past and Present Personal Health History (check if applicable) Diseases of the heart or arteries Cancer Epilepsy Diabetes Anemia High Blood Pressure Diabetes Mellitus Asthma lung diseases Angina Pectoris (chest pain) Orthopaedic or muscular problems Stroke Other
Height Weight Blood Pressure BF% YES to one or more questions: You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health. NO to all questions: It is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels. I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. I also accept the sole responsibility for any injury that I may sustain by participating in Sports & Fitness and understand that Highdown Sport & Leisure Ltd may in no way be held responsible. My signature on this form releases and holds harmless the Highdown Sport & Leisure Ltd including all the employees whom work for Highdown Sport & Leisure Ltd and personnel from any and all liability and claims relating to any possible injuries sustained as a result of my participation. Participation in this program and use of the facilities is at my own risk and completely voluntary. I declare that I have been informed there is no Lifeguard on duty during all times of use, I still wish to swim and I understand that by signing this declaration I forfeit my right to assign blame to Highdown Sport & Leisure Ltd of any accident or injury that I may cause myself using these facilities (Gym & Swimming Pool). If anything should change on your par Q you have to inform an instructor. Print Name Signature Date Instructor Name Signature Date Doctors Referral note: Having said yes to one off the above questions, I have taken medical advice and my doctor has agreed that I should exercise Doctors Name Doctors Signature Date te: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the questions. If your condition changes you should inform an instructor immediately. This document will be kept on record under the Data Protection Act.
Highdown Sport and Leisure Ltd Gym membership contract n Induction This form is for any new member joining the gym who does not wish to have an initial gym induction. You are still required to learn our health and safety procedures in place for new gym members, including the identification of all fire exits, how to raise the alarm and what to do in the event of an emergency. This should be delivered by one of our fitness coaches instead of the full gym induction. By signing this contract you are confirming that you have been informed on the following: 5. Location of fire exits closest to the gym 6. Where to report to if the building is evacuated 7. How to raise the alarm in the event of an emergency You are also confirming that you are already competent in using the following with correct technique and have appropriate safety knowledge: 1. Using cardiovascular gym equipment including treadmills, x trainers, rowing machines, recumbent bikes and upright bikes. 2. Using resistance machines including chest press, leg press, leg curl, leg extension, shoulder press, seated row, lat pull down, cable machines and leg adductor/abductor. 3. Using free weights including dumbbells and barbells. If you ever require any assistance or would like to undertake a full gym induction please let a member of staff know and they will be happy to do so. Name: Date: Signed:
ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Highdown Sports & Leisure Ltd Name of the Activity or Event: Badminton Gym equipment Swimming without a lifeguard. Date of Activity or Event: / / I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS ACTIVITY, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared or trained for participation in the activity or event, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activity or event in which I may participate, and that it will govern my actions and responsibilities at said activity or event. (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me. the directors, officers, employees, of Highdown Sports Centre. (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise. I acknowledge that Highdown Sports Centre their directors, officers, staff, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific event or activity. I acknowledge that this activity or event may involve a test of a person s physical and mental limits and may carry with it the potential for injury. The risks may include, but are not limited to, those caused by facilities, temperature, condition of participants, equipment, actions of other people including, but not limited to, participants, volunteers, spectators. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. Participant s Name Signature, Date
Terms & Conditions 1. The terms and conditions apply to the gym membership contract between you (the member named on the Membership Agreement) and us, Highdown Sports & Leisure Limited as from the Membership Valid from date set out on the Membership Agreement. 2. By signing the Membership Agreement you are agreeing to become a member of Highdown Sports & Leisure Limited and be bound by the Terms. 3. When signing up for membership a photo will be taken to add to your profile which will relate to your health and safety, check in s and registers. 4. Membership is payable for a full month at the start of each month by Direct Debit. 5. You will pay your membership depending on which payment option chosen by you: being either, Monthly membership/no contract or Annually/all up front/13months. 6. If you chose to pay by monthly direct debit and you sign up in the middle of the month you will be required to make an initial pro rata payment for the first month. Then the direct debit start at the beginning of the next month. 7. If you chose to pay for a monthly membership an initial payment for the band will be required. Initial payment for the band does not apply for those who chose to pay for annual membership. 8. If you lose your band you will have to pay 5 for a replacement. 9. Should you pay full amount up front for the annual membership for a period of 13 months, your membership will come to an end upon expiry of the 13 month period, unless you chose to renew into a new membership. We will contact you in advance to keep you informed and whether you want to renew or not. 10. We do not offer refunds for non-usage of sports facilities. 11. You may only cancel annual membership under certain criteria, if you are moving away/house or changing job that is outside the area/region of 30 miles. If you fall into that criteria and wish to cancel annual membership, there will be a charge of 22.50 for immediate cancelation. 12. You may only cancel your monthly membership by giving us at least one calendar months notice to cancel your membership to take effect at the end of the calendar month. tice will only be accepted by email. 13. There is no minimum term of membership, therefore notice can be submitted at any time. 14. This membership cannot be shared with any person other than yourself. 15. You must swipe in and wear your band each time you use the gym. 16. You are entitled to use the facilities at specified times only, shown in the timetable. 17. If you are on the annual membership paying upfront you may suspend your membership. Suspension must be for a minimum of one calendar month and will take effect from the beginning of a calendar month. 18. To be a member at Highdown Sport & Leisure Limited you must be aged 18 years or over. 19. Liability o o o You use our facilities, appliances and services entirely at your own risk and we have no liability to you for any loss, injury or damage sustained or incurred by you or your property, unless due to negligence or fraud by us or our staff. If you use any piece of equipment supplied by us, you must be competent in its use or have received instruction by a member of our staff as to its safe use. If you participate in any Physical Activity classes or make use of our facilities you are responsible for ensuring that you are properly equipped and that your state of health and physical condition is such as not to involve any risk to you or any other person using our facility.
20. Direct Debit o This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society. If the amounts to be paid or payment dates change Highdown Sport & Leisure Limited will notify you 10 working days in advance of your account being debited or as otherwise agreed. If an error is made by Highdown Sport & Leisure Limited or your Bank or Building Society you are guaranteed a full and immediate refund from your branch of the amount paid. o You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us. o Please note only UK bank accounts are acceptable for Direct Debit payments. o Please make sure that before you cancel your direct debit you have cancelled your membership appropriately, otherwise additional charges may occur. 21. Pre-Exercise Medical Screening 1. Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? 2. Do you feel pain in your chest when you do physical activity? 3. In the past month, have you had a chest pain when you were not doing physical activity? 4. Do you lose your balance because of dizziness or do you ever lose consciousness? 5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity? 6. Is your doctor currently prescribing medication for your blood pressure or heart condition? 7. Do you know of any other reason why you should not do physical activity? 8. Do you have a family history of heart disease, hypertension, stroke, diabetes, heart failure, lung disease or epilepsy? 22. We have the right to work or add any additional equipment to the facility without notifying you first. 23. You will be notified by email about any changes to timetable/opening hours during holidays/out of term hours in advance. 24. I have had the opportunity to ask questions regarding activities, use of equipment, and other related activities and to have the benefit of an induction programme. Any questions I have asked have been answered to my satisfaction 25. Questionnaire in the form of a Par-Q have been completed before any use of the gym or pool facilities is carried out. 26. If you have answered yes to any questions 1-8 on the Par-Q, we strongly recommend that you obtain your doctor s consent prior to exercise and you are advised to limit your activities to a moderate intensity, and undertake an induction before use of facilities. 27. I have read, understand and accept the rules, terms and conditions laid down by Highdown Sport & Leisure Limited and agree to abide by them. I understand that the Sports centre may from time to time make changes to the centre without prior notice. Print Name