SIGN UP FORM - OUTDOOR GROUP FITNESS
PERSONAL DETAILS
Name
Age
Phone
Address
Email
Emergency Contact No.
HOW DID YOU FIND US
DOB
Mobile
Name/Relation to Contact
Internet Search
Magazine
Poster
Flyer
Facebook
The Beast
Referral (Name)
Other:
SELECT YOUR START DATE, PREFERED PACKAGE (*) AND PRIMARIY LOCATION
(please circle one)
Start Date
Membership Package (*)
- Unlimited training at all
locations
Walking passed
_____ / _____ / _____
1 Month - $227/month
3 Month - $192/month
6 Month - $172/month
+ Running T-Shirt or Singlet
Bondi Beach
Coogee
CBD Domain
Primary Location
PRE EXERCISE SCREENING QUESTIONNAIRE
Have you had or do you have any current medical conditions? (Please Circle)
Diabetes
Epilepsy
Breathing Difficulties/Asthma
Muscular Pain/Cramps
High Cholesterol
Mental Illness
A Hernia/Back Pain
Pregnant
High Blood Pressure
Pain/Tightness in the Chest
Rheumatic Fever
Male, age >45yrs
Heart/Stroke Condition
Liver/Kidney Condition
Arthritis
Female, age >45yrs
Do you smoke cigarettes? Y/N
If yes, how many per day?
Do you have a close relative who has had a stroke, heart attack or cardiovascular disease? Y/N
If yes, what’s the relation and at which age did this happen?
Are you currently on any medication? Y/N
If yes, which medication?
Is there anything not listed above that you feel is relevant to mention or that may limit your training? Y/N
Have you been hospitalised recently? Y/N
If yes, what was the reason?
( * ) Please choose your preferred package if you know which one you would like. If you’re not sure, you can choose an option
during your trial, which you can always change later.
Team One Fitness ABN 56 924 318 903 [email protected] www.teamonefitness.com.au M: 0424 245 578 LIFESTYLE QUESTIONNAIRE
How would you rate your current fitness level? (please circle)
(10 being very fit)
How would you rate your current diet? (please circle)
Current Occupation
Rate your activity
levels at work
(Please Circle)
(10 having a very healthy diet)
Largely in-active
(eg. Desk job)
Lightly active
(eg. Teacher,
household)
Heavily active
(Bricklayer Labourer)
EXERCISE HISTORY
How often have you exercised in the
Duration of exercise?
last 6 months?
Never
Up to 30 min
1-3 times per week
30-60 min
4-5 times per week
60-90 min
5+ times per week
90+ min
What exercise(s) do you enjoy? Any particular likes/dislikes?
Level of daily activity?
Low
Medium
High
HEALTH AND FITNESS GOALS
What are your reasons for considering our Team One Fitness group classes?
What are your health and fitness goals? (Please Circle)
Improve General Health
Gain Strength
Muscle Toning
Build Lean Muscle
Weight Maintenance
Rehabilitate
Gain Weight
Flexibility
Upcoming Sport or Social Event Training (detail/date)
Lose Weight (please circle)
0 – 5 kg
5 – 10 kg
Is there anything else you think might be relevant for us to know?
Reduce Stress
Self-Esteem
Have fun/meet people
Increase Energy
10 - 20 kg
20+ kg
PHOTO CONSENT
I (Full Name) ____________________________
give permission to Yves Minten trading as Team One Fitness ("Team One Fitness") to use my:
Name
Testimonial
Image/Photograph
Yes □
Yes □
Yes □
No □
No □
No □
in publications and advertisements produced by or for Team One Fitness
I understand that these publications will also be placed on websites managed by Team One Fitness for public relations and
advertising purposes.
Signature: ____________________________________________Date: ____________________________
Team One Fitness ABN 56 924 318 903 [email protected] www.teamonefitness.com.au M: 0424 245 578 BAD WEATHER, PUBLIC HOLIDAY, PAYMENT, CANCELLATION POLICY
1. I acknowledge and agree that due to the amount of days in a month, bad weather, public holidays, some weeks/months will have
more or less sessions then others. Regardless from the amount of sessions the agreed monthly, three monthly or six monthly fee
will still be charged.
2. I acknowledge that sessions still occur in bad weather but we reserve the right at our discretion to cancel any session for
unforeseen circumstances, including but not limited to bad weather or public holidays. These cancelled sessions will be forfeited.
3. I agree that missed sessions are forfeited unless there is an agreed upon extended client absence.
I understand that my 7-day trial starts from the start date (see above) and that my first monthly payment will be on the day after my
trial expires unless I give prior notice by email.
4. Team One Fitness membership are on an ongoing basis. Your membership will automatically renew when your package finishes
unless you provide us with written notification to [email protected] that you wish to suspend or cancel your membership
at least 3 days before the end of your package.
5. I understand that I can only freeze my contract for a minimum of 14 days after giving written notice by email to
[email protected]
Full Name (Print): ____________________________________ Date:____________ Signature: ___________________________
Witness (Print Name + Sign): ____________________________________________Signature: ___________________________
RECREATIONAL ACTIVITY WARNING
I, ____________________ acknowledge and agree as follows:
1. That by participating in any and each of Yves Minten trading as Team One Fitness activities (“Team One Fitness”), I am
undertaking a ‘recreational activity’ within the meaning of the Civil Liability Act 2002 (NSW).
I have been warned that there is a danger and a risk of personal injury or death in the Team One Fitness activities. I accept the
risk of injury, death, loss and damage that may occur.
2. Team One Fitness, it’s employees, directors, officers, instructors, contractors and agents are not liable to you, your dependants
or legal representatives in negligence, tort, breach of contract or statutory duty for personal injury, death, loss or damage suffered
by you from any Team One Fitness activities.
3. Team One Fitness excludes liability for breach of any express or implied warranty that the services will be rendered with
reasonable care and skill.
4. Team One Fitness shall incur no liability for consequential or other losses or damage whatsoever by entering into this
agreement to the extent permitted by law.
Full Name (Print): ____________________________________ Date:____________ Signature: ___________________________
Witness (Print Name + Sign): ____________________________________________Signature: ___________________________
We would love you to
our facebook page and follow us on www.facebook.com/teamonefitness to keep up to date with
what’s happening.
Thank you for completing the sign up form. Please return it to us before your first session by sending it by email to
[email protected] or simply bring it to your first session.
See you at training!
Team One Fitness ABN 56 924 318 903 [email protected] www.teamonefitness.com.au M: 0424 245 578