FOCUSIT GYM MEMBERSHIP FORM

(PLEASE COMPLETE IN BLOCK CAPITAL)

Personal Details:

Name:

Date Of Birth:

Email:

Faculty Status:

If you are Undergraduate/Graduate, in which year you will graduate or depart from the faculty?

Medical Details:

PLEASE CONSULT YOUR DOCTOR BEFORE BEGINNING ANY PROGRAMME OR PHYSICAL EXERCISE!

When was the last time you were in a regular program of exercise?

Currently

less than 1 year ago

1-3 years ago

3+ years ago

Have you used a gym before?

Yes

Have you ever had a gym induction before?

Yes

How often do you plan on using the Gym per week?

If you suffer from any of the conditions listed below, it is ESSENTIAL that you consult your Doctor and obtain approval before beginning a program of exercise:

Any serious disability	Heart problems/chest pain/angina/respiratory problems
Epilepsy	Recent involvement in a serious accident or undergone surgery
Asthma/Eczema/Hay Fever	Any back/neck/knee/shoulder problems
Shortness of breath	Any family history of the above
Diabetes	Any recurring illness in the past 6 months
High Blood Pressure

WARNING! By signing this form, you agree that if you do suffer from any of the above conditions, you have consulted your Doctor and obtained approval for beginning a program of exercise before joining the FOCUSIT Gym. You must also do this if you smoke or are/think you may be pregnant.

Membership Duration - (Student use only)

Please tick the appropriate box to indicate the length of membership required:

Annual membership - 20MYR per year

3 years membership - 50MYR per year

4 years membership - 65MYR per year

Induction:

The FOCUSIT Gym offers free inductions to all students and staff irrespective of an individual's previous gym experience. Whilst inductions are strongly recommended before using the Gym, they are not mandatory.

Would you like an induction session?

Calculate Your BMI:

Your Weight (in kg):

Your Height (in metres):

Your BMI:

Declaration:

PLEASE ACCEPT/DECLINE EITHER DECLARATION with induction or without induction (depending on whether or not you would like an induction session). THEN, PLEASE ACCEPT/DECLINE DECLARATION REGARDLESS OF WHETHER YOU WOULD LIKE AN INDUCTION at the last part.

DECLARATION (without induction):

BY ACCEPTING THIS FORM I DECLARE THAT:

I have read and understood this Membership Form and have answered all the questions to the best of my knowledge and belief at the time of signing.
If the answers to any of the above questions change at all, I must inform FOCUSIT GYM so that my Gym Membership can be reassessed.
I am aware of and understand the potential risks associated with physical exercise and I am voluntarily taking part in these activities with that knowledge.
By having been offered and declined a free induction session to the Gym I have had the opportunity to ask questions regarding activities, use of equipment, other related activities and to have the benefit of the induction programme. Any questions I have asked have been answered to my satisfaction.
Without prejudice to either the above or the Rules of the Gym, FOCUSIT Gym accepts no liability for loss or damage of whatever nature and however caused to me or suffered by me whilst on the premises, unless such loss or liability is caused by the negligence of members of FOCUSIT Gym.

Decline

DECLARATION (with induction):

BY ACCEPTING THIS FORM I DECLARE THAT:

I have read and understood this Membership Form and have answered all the questions to the best of my knowledge and belief at the time of signing.
If the answers to any of the above questions change at all, I must inform FOCUSIT GYM so that my Gym Membership can be reassessed.
I am aware of and understand the potential risks associated with physical exercise and I am voluntarily taking part in these activities with that knowledge.
By having accepted the offer of a free induction session to the Gym I have had the opportunity to ask questions regarding activities, use of equipment, other related activities and to have the benefit of the induction programme. Any questions I have asked have been answered to my satisfaction.
Without prejudice to either the above or the Rules of the Gym, FOCUSIT Gym accepts no liability for loss or damage of whatever nature and however caused to me or suffered by me whilst on the premises, unless such loss or liability is caused by the negligence of members of FOCUSIT Gym.

Decline

DECLARATION (sign this regardless of whether you want an induction):

BY ACCEPTING THIS FORM I DECLARE THAT:

I have read, understood and agree to abide by the FOCUSIT Gym Terms and Conditions.
I consent to and agree to pay the membership fee to the FOCUSIT Gym to provide for the maintenance and replacement of the gym equipment.
I understand that breach of any of the Gym Rules will result in the temporary or permanent revocation of my Gym Membership.
I have paid particular attention to the section of the Gym Terms and Conditions entitled ‘Liability’ and understand its implications.

Decline

Date: