All gym members must be 16 or over to join
Please enter your details honestly an correctly to complete your membership application.
Your name Address & Postcode Date of Birth Contact Number Your email
============================================================== Next of Kin Information
Next of Kin Name
Next of Kin Contact Number
Next of Kin Relationship to member (e.g. Spouse, Sibling, Friend)
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Membership: AdultStudent
Membership Duration: DailyMonthlyAnnuallyJoint Annually
Physical Activity Readiness Questionnaire
Please complete this questionnaire before attending Kiveton Park Health & Fitness Suite
Please read carefully:
If you select any of the ‘yes’ options below you must have a Doctor’s consent before commencing in any activity.
Has your doctor ever said that you have a heart condition and recommended only medically supervised activity? YesNo
Do you have chest pain brought on by physical activity? YesNo
Have you developed chest pain in the last month? YesNo
Do you tend to lose consciousness or fall over as a result of dizziness? YesNo
Do you have a bone or joint problem that could be aggravated by any proposed activity? YesNo
Has the Doctor ever recommended medication for your blood pressure or a heart condition? YesNo
Are you aware, through your own experience or from a Doctor’s advice, of any other physical reason why you should not exercise without medical supervision? YesNo
Are you currently, or have been pregnant in the last six months? YesNo
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Kiveton Park Health & Fitness Suite Ltd (KPHFS) accept no liability for accidents, injuries or illness however caused whilst using the gymnasium. All patrons use the gymnasium at their own risk.
Data Protection
On joining the gym we require details from you for membership reasons.
These may include some or all of the following on paper, electronic format or on membership software: – Health questionnaire – Email address – Telephone numbers
All paper copies of your details are held securely on site and can only be accessed by KPHFS members of staff.
Your information will not be shared with any third party companies, that it will be stored securely and will only be used within Kiveton Park Health & Fitness Suite Ltd.
Please Sign Your name below to confirm that all information given above is correct and that you agree to us storing your information as a member Kiveton Park Health & Fitness Suite Ltd.
