BECOME A MEMBER BECOME A MEMBER - 6 MONTHS "*" indicates required fields 1Personal Information2Waiver Personal informationName* First Last Email* Date of Birth* DD slash MM slash YYYY Mobile* Address Suburb* Post Code* Occupation Employer WaiverPlease nominate your friend who referred you (if they are a currernt member) Have you ever been a member of a Health Club before?* Yes No Health Club (When and Where) Do you have, or have you had any of the following?Heart Disease or any cardiovascular codition* Yes No High Blood Pressure* Yes No A major illness, injury or surgery in the last 5 years* Yes No Any history of Coronary Heart Disease in your family* Yes No Diabetes* Yes No Do you smoke tobacco* Yes No Arthritis or other joint/muscular pain* Yes No Asthma or difficulty in breathing* Yes No Epilepsy* Yes No Dizziness, blackouts, or fainting spells* Yes No If yes to any above, please give detailsAny pain or major injuries, particularly in the following areasNeck* Yes No Back* Yes No Wrist* Yes No Ankles* Yes No Arms* Yes No Knees* Yes No Upper BodyLower BodyAre there any other conditions which may be the reason to modify your exercise program?Are there any medical problems that may affect your excercising (e.g. surgery, recovering from illness, pregnancy, virus etc.?)Consent* I hereby certify that I willingly participate on my own free will in exercise(s) at Higher Ground Fitness. I warrant that I am physically and mentally sound to proceed with a program of exercises. I acknowledge that at all timess while on the Higher Ground Fitness premises, both my property and my person shall be at my own risk. I have read the current members procedure, the terms which I agree to observe and abide by. I agree to fulfil these financial commitments even in the event of my not attending Higher Ground Fitness or utilising it's service.*Consent* I agree to Higher Ground Fitness Agreement Rules*NOTICE TO MEMBERS THAT PAYMENT IS REQUIRED ON NEXT PAGE
