BALGA
Leisurepark
INGLEWOOD
Terry Tyzack
Aquatic Centre
Cnr Princess &
Camberwell Roads
BALGA
WA 6061
62 Alexander Drive
INGLEWOOD
WA 6052
Tel: 9205 7340
SCARBOROUGH
173 Gildercliffe Street
Scarborough
WA 6019
Tel: 9205 7490
Tel: 9205 7720
Membership Application Form
Membership Number:
Terry Tyzack Aquatic Centre Leisurepark Balga Scarborough
Name: D.O.B.
Address:
Suburb:
Phone (H):
(Mob):
(W):
Postcode
Male
Email:
Emergency contact: How did you hear about us?
Friend
Website
Advertising
Female
Phone:
Yellow / White Pages
Drove past
Other
If other (Please write a brief description):
Office use only
Membership Type:
Peak Diamond
Gym
Swim+ Multi Pass
Off-peak Gold
Pool
Aqua Multi Pass
Corporate
Silver
Classes
1-Month
3-Month 6-Month 12-Month 12-Month D/D
Trial period:
Additional Notes:
Gift Voucher:
Amount due:
Start date: Expiry:
Fee paid:
Payment type:
Cash
Cheque
EFTPOS
Date of payment: MasterCard
Visa
Time of payment:
Receipt no:
Cooling-off period
This agreement is subject to a 48-hour cooling-off period.
Strictly no refunds available outside of this cooling-off period.
All members reserve the right to cancel their membership, without giving cause or reason, during the 48-hour period immediately after they enter into the
membership agreement. Any requests for termination during the 48-hour cooling-off period must be made to the Health & Fitness Centre in writing. Any
membership fees paid will be refunded minus any fitness services the client may have utilised prior to termination, plus any reasonable administration
charges (min $20).
Release from liability/indemnity
I hereby declare that the above particulars are true and correct and I will adhere to the TERMS AND CONDITIONS (see overleaf). I acknowledge and
agree that during all such times as I am on the premises of the Health & Fitness Centre or its surrounds that both my property and my person shall be at
my own risk in every respect and hereby disclaim and release the City of Stirling and every occupier thereof, all employees, volunteers and invitees to the
full extent permitted by law whether in contract or in tort, and whether arising out of any negligence by any person or otherwise, and from all my liability of
any kind, which may arise in respect to any accidents or damage to property or injury to any person on the Centre premises, or its surrounds. I warrant that
I am in good state of health, fitness and physical condition and that there is no medical reason whatsoever that could be regarded as a restriction upon
or an impediment to my application for membership. In the event that any infant, minor or mentally or physically impaired person under my control shall
accompany me to the Health & Fitness Centre or its surrounds and that person suffers any personal injury or loss of property, then I shall indemnify the City
of Stirling against all and any claims, demands and actions made by or on behalf of the said infant, minor or impaired person in respect of any injury or
loss.
Member’s Signature:
Date:
//
Centre Representative:
Date:
//
Time:
BALGA
Leisurepark
Cnr Princess &
Camberwell Roads
BALGA
WA 6061
Tel: 9205 7340
INGLEWOOD
Terry Tyzack
Aquatic Centre
62 Alexander Drive
INGLEWOOD
WA 6052
SCARBOROUGH
173 Gildercliffe Street
Scarborough
WA 6019
Tel: 9205 7490
Tel: 9205 7720
Terms and Conditions
Termination of Membership
• The Health & Fitness Centre has the right at any time to terminate the membership of any person who has behaved or is behaving in an inappropriate
manner in or in relation to the Centre or does not comply with the reasonable direction of the Centre staff, additionally it reserves the right to suspend
access if the Centre is aware of any charges being brought against the member until such charges have been resolved. This is in the best interest of the
health & safety of all customers and staff at the centre and those participating in any program or activity organised by the Centre.
• Only memberships paid by direct debit can be cancelled and will be subject to a cancellation fee payable at the Health & Fitness Centre Reception. Any
member cancellation requests must be made in writing. If the member terminates the agreement or stops the direct debit arrangement in a manner not
described in this agreement, the member will be considered in breach of contract and liable for the cancellation fee outlined in the current Schedule of
Fees and Charges.
Payment Declaration
I agree that payment for membership fees must be made upfront at the time of joining (excluding direct debit membership).
I agree that the liability for the above payment shall continue as agreed notwithstanding my frequency of attendance at the centre or that I shall cease to
attend altogether. I shall not be entitled to any refunds for any reason. As a member, I shall cease to have rights to the centre, at its discretion, if full payment
is not received by the due date. As a member, I shall pay all costs of the collection of the monies due including any debt collectors, legal fees or other
cost payable by my defaults. I acknowledge that I have read and understand all of the above provisions as well as the centre rules and regulations and
acknowledge that this is a legally binding contract and that I observe to be bound by it.
Suspensions
Memberships can be suspended as follows:
• 12-month membership = 8 weeks suspension
• 6-month membership = 4 weeks suspension
• 3-month membership = 2 weeks suspension (Leisurepark Balga only)
• The suspension fee is outlined in the current Schedule of Fees and Charges and the duration of the suspension is added to the current end date of the
existing membership. The Member must complete and sign a Suspension Form prior to the intended leave, stating exact dates of suspension, which is
available from Health & Fitness Reception.
Transfers & Refunds
• Non-direct debit memberships only may be transferred to another person. Terms and conditions apply.
• Strictly no refunds are available outside of the cooling-off period.
Health & Fitness Centre Rules
• Sweat towels are compulsory – no towel, no workout. Ensure you wipe down the equipment you have been using in preparation for the next user.
• Enclosed shoes are compulsory.
• Gym patrons must refrain from using expletives or other language that could be considered offensive to other users.
• During peak periods, time limits apply on cardio equipment (time limits are posted).
• Please allow people to work in with you during your rest periods.
• Gym patrons must unload their weights from machines they have been using in preparation for the next user.
• Please do NOT drop weights on the ground. It is not necessary and increases the downtime of equipment through damage to the dumbbells/barbells and
the floor.
• The instructors are here to help. If you need assistance please feel free to ask an instructor.
•Members must sign the declaration on the front of this membership application form and complete a health questionnaire before commencement.
Appraisals and programs are included in all memberships (excluding Terry Tyzack Aquatic Centre 1-month memberships).
• Lockers are available to members, ask at Reception.
• Your membership card must be scanned to allow entry to the centre. If a card is lost a replacement card must be purchased, for the fee outlined in the
current Schedule of Fees and Charges.
• Group Fitness Classes are subject to availability and timetable is subject to change without notice.
• All multi passes expire two (2) years from date of purchase.
• If you have any suggestions on how to improve the centre there are suggestion boxes located at Reception.
Aquatic Centre
• Lane availability is subject to change at the discretion of the Aquatic staff.
• Please follow the lane signage, as there are fast, medium and slow/walking lanes allocated.
• Please keep left whilst swimming. Swim past on the right to overtake.