FIRST NAME: SURNAME: ADDRESS: EMAIL: MOBILE: DOB: HOME TEL: EMERGENCY CONTACT: CONTACT NO: (the person we will contact in case of emergency. If under 18 years of age please use parent or guardian) PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (Please answer ALL questions carefully) Have you ever/do you currently have a heart condition? YES / NO Have you ever experienced a stroke? YES / NO Have you ever/do you currently have epilepsy? YES / NO Have you ever/do you currently have diabetes (which type/any medication) YES / NO Have you ever/do you currently experience chest pain when engaged in physical activity? YES / NO Have you ever/do you lose consciousness or suffer with dizziness? YES / NO Do you have low/high blood pressure? (how is this controlled) YES / NO Have you ever/do you currently have a respiratory disorder? YES / NO Have you ever been treated for a bone, joint or soft tissue injury? YES / NO Are you pregnant or had a baby in last 3 months? YES / NO MEDICAL HISTORY Please give details of any prescribed medication and for what condition or any additional information relating to the above questions (relevant to you taking part in physical activity) Do you suffer from any allergies? OUR DETAILS:
Our business’s name is: New Dawn Fitness
Our business address is: 84 High Street, Cranleigh, Surrey GU6 8AH
Our contact details are: +44 (0)7946 854342
CLIENTS SIGNATURE: DATE: NEW DAWN FITNESS: DATE: By signing the above you agree to the terms and conditions set out on the website and set out below. My participation in any form of fitness training carried out by staff at New Dawn Fitness is voluntary. The information I have provided is correct to the best of my knowledge and any changes to my health will be provided from hereon. Apart from any conditions previously mentioned, I am in good physical condition, capable of performing active or passive exercise without detriment to my health, safety or physical comfort. Training sessions consist of activities that are designed to gradually improve the efficiency with which the body functions, no guarantee of improvements can be made. Exercise levels will be progressive and regulated by the trainer. During the training sessions and for a period after, you may experience local muscular soreness and some fatigue. These minor discomforts very often disappear within 48 hours. The reaction of the body to such activities cannot always be predicted. There are risks during or following exercise. These include abnormalities of blood pressure, heart rate or in very rare cases cardiac complications. Should you feel unwell during any training session please let the trainer know immediately. Your trainer is a qualified first aider and is aware of emergency procedures. All information acquired is treated with the strictest confidentiality and only shared with personnel of New Dawn Fitness. Before signing and attending any training sessions ensure that any questions have been answered. If you are still unsure please discuss your participation with your doctor. I have been advised at New Dawn Fitness that my current health conditions or age may affect my exercise routine in a negative way. I have also been advised to see my doctor before participating in an exercise programme. I have decided not to visit my doctor. I am aware of the risks and take full responsibility if anything should happen to me while under instruction at New Dawn Fitness. Therefore, in consideration of gaining access to participate in physical activities I do hereby waive, release and forever discharge any instructors at New Dawn Fitness from any of the responsibilities or liability for injuries or damages resulting from my participation. I understand the policies and procedures set forth by New Dawn Fitness and have had the opportunity to discuss my specific needs in relation to participatory activity and as a result, I do voluntarily request the right to participate in the preventive programme of exercise. Also, in consideration of the above factors, I acknowledge the existence of the risks in connection with these activities, assume such risk and agree to accept the responsibilities for any injuries sustained by my participation via the use of the facilities and/or it’s equipment. Most specifically, I acknowledge and accept responsibility for injuries arising out of these activities that involve risk in any of the following areas: The use of equipment, the performance of fitness related evaluations to assess functional capacity, the participation in group activities related to exercise and activity and incidents that occur within the institution facility. Having read the preceding, I acknowledge full understanding of these risks set forth herein and knowingly agree to accept full responsibility for my own exposures to such risk and waive full responsibility and liability on behalf of New Dawn Fitness. OUR DETAILS:
Our business’s name is: New Dawn Fitness
Our business address is: 84 High Street, Cranleigh, Surrey GU6 8AH
Our contact details are: +44 (0)7946 854342
Class Plans and Payments
Name: ………………………………………………………………..……………………………………………………
Start date:………………………………………………………………………………………………………………..
Monthly class plan
£45pm
1:1 session
£60
Bronze Personal Training plan
£
Bronze Buddy Training plan
£
Silver Personal Training plan
£
Silver Buddy Training plan
£
Gold Personal Training plan
£
Gold Buddy Training plan
£
Fitcamp
£200
Course/Workshop (please state which one & date)
Total
£
Please debit my credit/debit card
Card Number:………………………………………………………………………………………………………..…
Name on card:……………………………………………………………………………….…………………………
Expiry: ………..…………………………….. CV(3 digit on back):……………………….
I agree to the terms and conditions www.newdawn-fitness.co.uk
Signed:………………………………………………………………………………………………………………..
OUR DETAILS:
Our business’s name is: New Dawn Fitness
Our business address is: 84 High Street, Cranleigh, Surrey GU6 8AH
Our contact details are: +44 (0)7946 854342
Date:…………………………….. TERMS AND CONDITIONS for www.newdawn-‐fitness.co.uk Definition: New Dawn Fitness Studio providing fitness, yoga and Pilates services as set out on website. Prices: Prices include pay as you go, monthly class plans, courses, workshops and any event for a set period of time (see timetable or website for details and prices). Price increases and changes: Information on any price increases or changes will advised via email, displayed in the studio and/or on our website, social media and may occur at any time that is required by the studio. Any payment already received within a given month will be honoured at the original price paid and any increase will take effect from the next month payment is due or date stated in notification. Monthly Class Plans: st
th
Monthly class plans commence on 1 of any month, payment on 30 of any month in advance. Initial membership sign up is for a minimum period of 6 months, thereafter your membership is on a rolling monthly basis and can be cancelled at any time with 3 working days notice through the studio. 2 classes per week are guaranteed at sign up and you must state which 2 classes per week you would like us to reserve for you. Thereafter, additional classes may be taken at the additional cost of £5 per class. Method of payment: Initial payment of full month is payable upon completion of application form with debit or credit card. Thereafter, payment will be automatically generated on 30th of each month thereafter. Late or non-‐payment: Should a monthly payment be returned or declined for any reason the clients account will be temporarily suspended until full payment is reinstated or provisions for payment to be met has been established with the studio. Any failed transactions for monthly payments, expired or cancelled cards will incur an admin fee of £25 and remains the responsibility of the client to inform New Dawn Fitness of the new card details. Booking classes/1:1 sessions/personal training/workshops/courses: All classes and courses should be booked online or in person through New Dawn Fitness in advance and paid for in full at time of booking. In the event of a class or session being full a place on the waiting list will be offered with confirmation of your place, should one become available. Non attendance of any class if not cancelled outside of 2 hour window is subject to £5 fee and will be charged to the card used against your account. Cancellations/refunds: Monthly payments are not refundable or transferable and the responsibility falls on the client to cancel the payment arrangement directly through the studio should they not wish to continue attending New Dawn Fitness. Classes and sessions can be cancelled through the online booking system at New Dawn Fitness website. A two-‐hour window from class/session start time is in place to cancel or amend without loss. Courses are non-‐refundable or transferable. Personal training and 1:1 sessions require 24 hours notice before start time of session otherwise full loss of monies will be incurred. The studio reserves the right to cancel any course, event or workshop that does not meet the minimum number required to run and will, in this case, fully refund any monies received. Confidentiality: Every effort will be made by New Dawn Fitness to secure any information provided by the client in forms and internet and will comply with the Data Protection Act. No information will be passed onto third parties. OUR DETAILS:
Our business’s name is: New Dawn Fitness
Our business address is: 84 High Street, Cranleigh, Surrey GU6 8AH
Our contact details are: +44 (0)7946 854342