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Trial Membership
*To activate your trial please complete your details below and accept the terms and conditions.
Your Details
Name:  *
Contact #:  *
Email:  *
Surname:  *
ID #:  *
If under the age of 18, please let your parent/legal guardian complete the following.
Parent/legal guardians’ details:
Name:
Contact #:
Email:
Surname:
ID #:
Start Date: 21 May 2012
End Date: 24 May 2012
PAR Q - Physical Activity Readiness Questionnaire (Indicate where applicable)
Yes       No
Do you suffer from heart trouble?        
Are you diabetic?        
Have you ever experienced heart and/or chest pains?        
Do you sometimes fell faint or have spells of severe dizziness?        
Do you suffer from asthma, emphysema or bronchitis?        
Do you suffer from thyroid problems?        
Have you suffered from any of the following?
  • Shortness of breath, most prominent upon exertion
    		•         
  • Heart palpitations
    		•         
  • Peripheral Vascular Disease (vein inflammation)
    		•         
  • Leg cramps when active
    		•         
  • Persistent swelling around ankles
    		•         
    Are you pregnant?        
    Do you currently, or have you in the past, suffer from bone or joint problems, like arthritis, which could be aggravated or made worse with exercise?        
    Are you male, aged 55 or older OR are you female, aged 65 or older?        
    Have you ever had high blood pressure?        
    Has anyone in your immediate family suffered from heart disease, before the age of 55?        
    Are you currently a cigarette smoker or have you smoked in the last 6 months?        
    Have you ever suffered from high cholesterol?        
    Do you do less than 3 hours of physical activity (Housework, gardening, walking, etc.) per week?        
    Release & Waiver of Liability Details
    • Use of the club facilities, equipment, services, programs and premises involve an inherent risk to injury to persons and property.
    • I am medically and physically fit to use an exercise program and the facilities.
    • I have consulted a physician and he/she has approved my contemplated activities at the club.
    • I waive all claims which I might have against the club and hereby indemnify the club in respect of any claims that might arise as a result of my using the facilities and programs.
    • The club is not responsible for lost or stolen articles. I undertake to keep valuables with me or locked away at all times while using facilities.

    Terms & Conditions

    • Trial memberships are to experience the facilities and for the purpose of joining the club.
    • Approval of a trial membership may only be granted every 6 months per individual.
    • Positive ID will be requested before the membership can be redeemed.
    • Trial memberships are non-transferable & non-refundable for cash.
    Security Code: Type the characters you see in the picture below.
     * 
    I read, understand and accept the Release & Waiver of Liability and terms & conditions of this trial membership.
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