Application | Power Up Gym Bradford | Gym & Wellness Centre

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Home
About Us
- Location
- News & Updates
Fitness
Wellness
- Beauty
- Nutrition
Pricing
Contact

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Application Form

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Name *

First

Last

Full address *

Contact number *

Email *

Student/NHS number

Do you have a disability? *

Field #9 (copy)

Have you, for any reason, been unable to exercise in the past? *

Has your physician ever advised you against exercising? *

Have you ever suffered from any cardiac (heart) related illness? *

Have you ever suffered from respiratory difficulties? *

Have you ever suffered from fainting, migraines or loss of balance? *

Have you ever suffered from any bone, joint or muscle related disease? *

Is there any history of heart disease in your family? *

Have you experienced chest pain whilst exercising? *

Do you have high blood pressure? *

Do you have elevated cholesterol levels? *

Are you currently taking prescribed medication? *

I 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 agree

Data 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.

DECLARATION *

Enter your name here.

DATE *

Enter today's date here.

Independent gym and wellness centre in Bradford BD6
Mercon House, 531 Beacon Rd, Bradford BD6 3NB | Contact us