Sign Up! About You First Name (required) Surname (required) Date of Birth (Required) Email Address (Required) Contact Number (Required) Membership Type (Required) Off peak (9am-3pm) everyday £20per monthFull membership £23.99 per month (6am-10pm) everyday plus classesGold membership £25 per month full membership benefits plus bring a friend once a week for free (message Donna to confirm each time ) Address Address Line 1 (required) Address Line 2 (required) Address Line 3 Town (Required) County (Required) Post Code (Required) Your Health Has your doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggravated by exercise or might be made worse with exercise? (Required) NoYes Do you have high blood pressure? (Required) NoYes Do you have low blood pressure? (Required) NoYes Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by your doctor? (Required) NoYes Have you ever felt pain in your chest when you do physical exercise? (Required) NoYes Is your doctor currently prescribing you drugs or medication? (Required) NoYes Have you ever suffered from unusual shortness of breath at rest or with mild exertion? (Required) NoYes Do you often feel faint, have spells of severe dizziness or have lost consciousness? (Required) NoYes Do you know of any other reason why you should not participate in a programme of physical activity? (Required) NoYes Physical Actvity Readiness Questionnaire (PAR-Q) If you answered YES to one or more questions: If you have not recently done so, consult with your doctor by telephone or in person before increasing your physical activity and/or taking part in exercise. Tell your doctor which questions you answered YES to or present this PAR-Q. After medical evaluation, seek advice from your doctor as to your suitability for: Unrestricated Physical Activity starting off easliy and progressing gradually, and Restricted or Supervised Activity to meet your specific needs (at least on an initial basis) If you answered NO to all questions: If you answered this PAR-Q accurately,you have reasonable assurance of your present suitability for: A Graduated Exercise Programme A Fitness Appraisal Privacy Policy The Gymbox61 is passionate about your privacy and the privacy of your data. All the personal data you have supplied to us above will be stored securely and will not be transferred or passed on to anybody outside of The Gymbox61. We will use your data to ensure the health and safety of yourself and other gym users, as well as notify you in case of any changes / emergencies at the facility. Data will be stored even if you are no longer a member of the facility as proof of compliance to exercise, as well as any injuries / illnesses / current medication you notified The Gymbox61 of when using our products / services. Payment Policy Payments are taken via direct debit on the same date every month (unless it falls on a weekend / bank holiday, in this case it will be taken on the following working day). It is your responsibility to cancel gym membership by cancelling your direct debit and that in no circumstances will refunds be provided by The Gymbox61 even if you do not use the facility / classes. Assumption of Risk I hereby state that I have read, understood and answered honestly the questions above. I have also read and agree with all terms and conditions. I state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I am free from injury/illness. I realise that my participation in these activities involves the risk of injury and I accept full responsibility. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise in the gym and will inform The Gymbox61 of any changes in my health / well being / medication / contact details whilst a member of The Gymbox61. Check this box to confirm you agree to all of the above