Power Up Gym join thecommunity Application form BD6Gym Please enable JavaScript in your browser to complete this form.Full name *FirstLastFull address *Contact number *Email *Please make sure this is correct so you receive any important emails.I can confirm I am aged 16 and above *YesWe accept members aged 16 and above.Student number and expiry (if applicable)ID will be need to be presented on induction.Do you have a disability? *NoYesHave you, for any reason, been unable to exercise in the past? *NoYesHas your physician ever advised you against exercising? *NoYesHave you ever suffered from any cardiac (heart) related illness? *NoYesHave you ever suffered from respiratory difficulties? *NoYesHave you ever suffered from fainting, migraines or loss of balance? *NoYesHave you ever suffered from any bone, joint or muscle related disease? *NoYesIs there any history of heart disease in your family? *NoYesHave you experienced chest pain whilst exercising? *NoYesDo you have high blood pressure? *NoYesDo you have elevated cholesterol levels? *NoYesAre you currently taking prescribed medication? *NoYesI agree that if I have answered ‘yes’ to any of the above questions in the Physical Activity Readiness Questionnaire (PARQ), I understand I am recommended to contact the GP prior to using the gym. *I agreeData Protection Act 1998 *I consent that the data collected on this form will only be used for the purpose of IT user account administration within Power Up Gym Ltd and will not be disclosed to any external sources without your express written consent. Both electronic and paper records will be deleted/shredded when your membership account is closed. elevated using have Declaration *Date *Proceed to payment options
