Staff: ______________
Membership Start Date: _________________
Membership Number: ___________________
Membership Type:______________________
Title:
Mr.
Mrs
Miss.
Ms.
Sex: Male
Female
Name:
Address:
/
Suburb:
Phone:
Postcode:
Date of Birth:
Mobile:
Work:
Email:
Emergency Name:
Emergency Contact:
MEMBERSHIP TERMS AND FEES
UPFRONT (due on date of signing)
1. PAID IN FULL MEMBERSHIP
DIRECT DEBIT
2. DIRECT DEBIT MEMBERSHIP
$
$
$
Joining fee* Not applicable on aquatic m/ship
$
Weekly Rate
$
Administration Fee
Special Conditions:
Joining fee* Not applicable on aquatic m/ship
Membership Rate/Fee
initial
For Terms of Direct Debit refer to Direct Debit Request (DDR) and Contract
PLEASE INITIAL CLAUSES BELOW:
If you fail to make complete payment at any given time you will be notified and given 14 days to remedy the outstanding
payments. If you have not remedied the situation within 14 days we will inform you in writing of the action we will take and
you will be suspended from using the Centre until arrears are paid in full.
I understand that after minimum period, the account will continue to be charged at the monthly rate unless I give Moss Vale
Aquatic Centre notification to temporarily suspend or cancel my membership.
Notification to temporarily suspend or cancel my membership must be in writing and within 30 days of the next
monthly/fortnightly/weekly billing date to successfully suspend or cancel my membership. If notification of intent to suspend
or cancel is not received 30 days prior, the account will be charge as agreed.
I understand the above membership rate will apply unless the centre provides me with a minimum of 60 days written notice
of fee changes. I understand that a $_________ cancellation fee will apply should I choose to cancel my membership prior
to the minimum membership period of _________ months.
I understand that I am entitled to a maximum of 4 weeks suspension time within a 12 month period, at $5 per week with the
minimum time being a one week suspension.
Membership suspension must be applied for in advance and will not be backdated under any circumstances.
PRIVACY DISCLAIMER:
As a member Moss Vale War Memorial Aquatic Centre you may be updated about the centre’s programs and other
information via SMS, email or mail from time to time. Opt out options will be available on all SMS communications.
LEGALLY BINDING AGREEMENT:
This agreement is legally binding whether my use of the facility and its services is determined and paid on a yearly, monthly,
weekly or individual basis.
The membership must remain current in order to avoid paying the joining fee again.
I declare that I am physically and medically fit and capable to engage in exercise and fitness programs at the Centre. I have
and will inform fitness instructors at Moss Vale Aquatic Centre of any condition or risk(s) that may have an effect on my
ability to participate in any exercise or fitness program prior to commencement.
I am 18 years of age or older at the time of signing. If not my parent / adult guardian will sign also.
I agree to the terms above and on the reverse of this form. (You should read these terms carefully and ask about anything
you do not understand).
Print Name:__________________________________ Signed:________________________Date: ___/___/___
Parent/Guardian Name:_________________________ Signed:________________________Date: ___/___/___
Terms and Conditions
with Centre Manager with 30 days’ notice for processing:
(a) Contact the Centre Manager
(b) The Centre Manager will organise an appointment for you to
complete a written cancellation form.
7. Transfer of Membership by the Member
1. Reception and Access
Memberships are not transferable.
(a) All members must swipe or present their card at reception and
8.
Replacement Card Fee
the gym every time they attend the centre.
(b) Members to advise any change of address and phone number. If a Membership Card is lost or destroyed and requires
replacement a Replacement Card Fee of $5.90 will apply.
(c) The facilities are available to the general public and not
9. Additional Fees for Special Service
exclusively for members.
Some services require an additional fee and these include but not
2. General Conditions of Entry
limited to: personal training, crèche and swimming lessons.
(a) We will refuse entry, or request any person to leave the
10. Damage to the Centre
premises if the person
(i) is abusive or uses offensive language or whose behaviour
Any member who wilfully or through their negligence damages of
is threatening or
any COS centre or its property will pay for the damage. Members
(ii) is under the influence of drugs or alcohol
are responsible for damages caused by their guests and children.
(b) No smoking permitted in the centre.
11. Safety, Maintenance and Service Demand
(c) No chewing gum permitted in the centre.
The Centre may from time to time as reasonably necessary:
To ensure the Centre is able to provide a high level of service in a
(a) Close off any part of the premises or isolate any pieces of
safe, healthy and pleasant environment for all, we ask our
equipment for maintenance or safety reasons.
members to comply with these conditions.
(b) Change the hours of opening and closing or alter class
3. Gym and Group Exercise Area Conditions
timetables in accordance with demand: or
(a) Weights MUST be returned to their correct place after use.
(c) Vary Centre rules. Where this occurs the Centre will provide
(b) Correct training attire and runners to be worn in gym - no
reasonable notice on the Centres notice boards or at
jeans, work clothes, boots, sandals, thongs, or clothing that is
reception.
likely to cause offence to others.
12. Damage & Personal Injury
(c) No person under the age of 15 is allowed in the gym. Children
Disclaimer
15-16 can use cardio equipment only and must complete a
To the extent permitted by law, all Centres exclude any liability to
Pre-Exercise Questionnaire with a parent/guardian.
the Customer in contract, tort, statute or in any other way for any
(d) No food allowed in the gym or group exercise classes.
injury, damage or loss of any kind whatsoever (including, without
(e) No entry to a group fitness class 10 minutes after it starts.
limitation, any liability for direct, indirect, special or consequential
4. Wet Areas (where applicable)
loss or damage), sustained by the Customer and/or any other
(a) No diving is permitted.
person, or for any costs, charges or expenses incurred by the
(b) No creams, oil or soaps allowed in the pool.
Customer, arising from or in connection with the Membership
(c) You must shower before entering pool.
Agreement and/or the services/products provided any of the
(d) Correct swim attire only in pool.
Centres, and/or any act of omission of the Centres
(f) Children are not allowed in pool area without parent.
13. Severability
(g) Parents to watch all swim lessons from designated area only.
(h) Dedicated areas of the pool are closed to members whilst In the event any part of this agreement being or becoming void or
unenforceable then that part shall be severed from this
Swim School lessons are being conducted. Times vary, are
Agreement with the intention that the balance of this agreement
posted and are updated regularly at the entry.
shall remain in full force and effect, unaffected by the severance.
5. Lockers (where provided)
14. Suspension Not applicable on aquatic m/ship
(a) All items stored in the lockers are at your risk and we do not
Suspension may be possible under the terms of this Agreement.
accept responsibility for items lost, damaged or stolen.
You may suspend for a minimum of 1 week at a time so long as
(b) Bags are not permitted in the club except to be placed in
the total time suspended within the minimum term does not
lockers provided.
exceed 4 weeks. In order to suspend you must contact the
6. Cancellation/Termination
Centre manager in writing with reasonable notice (at least 30
This agreement is subject to a 7 day cooling off period.
days unless reasonable grounds with evidence provided) prior to
(i) Cooling Off Period:
the date of suspension. There is a charge of $5.00 per week
(a) The cooling off period commences at the close of business on
dependant on the type of Membership while the Agreement is
the commencement Date.
suspended. Any time spent on suspension will be added onto the
(b) The cooling off period is 7 days.
minimum term of the Agreement so that the amount payable shall
(c) New members have the right to cancel their membership within
still be payable regardless of any suspension or suspension
the cooling off period if they are not completely satisfied with the
charges made.
service and programs.
15. Breach of Terms & Conditions
(d) All monies will be refunded on a pro rata basis with the
Any breach of these terms and conditions will result in a warning
exception of fees for services already delivered and an
and any further breach will result in a second warning and your
Administration fee whichever is the lesser of up to 10% of the
membership may be suspended or terminated. A proven serious
Membership Fee or $75.
(e) All ‘cooling off’ cancellations must be in writing to the breach of the general conditions of entry under 2(a) may result in
immediate termination of your membership without warning.
Centre manager.
16. Increase in Fees
(ii) Permanent Disability:
(a) Upon providing written advice of a permanent disability or
City of Sydney may at any time increase membership fees having
serious illness, along with a letter from a medical practitioner
given 30 days written notice sent to the members last known
detailing the disability or illness, the Centre may agree to
address.
cancel the membership for an Administration Fee whichever is
17. Direct Debit Membership Only
the lesser of up to 10% of the Membership Fee or $75
If you do not tick the box in the Direct Debit Request (DDR) &
(b) All monies will be refunded with the exception of charges for
Contract it is deemed to be an ‘ongoing membership agreement’
services already delivered.
and the agreement will continue until either you or the supplier
(iii) Direct Debit Membership post Minimum Term:
terminates it in the way described in the Direct Debit Request
Direct Debit Memberships can be cancelled after the end of the
(DDR) & Contract
initial minimum term by completing a cancelation form
All membership conditions have been put in place to ensure the
comfort and safety of all patrons. On acceptance by the centre of
this agreement you will be referred to as the “member” and have
the usage rights and obligations as detailed below