Title

Forename

Surname
Date of Birth
Address
Town
County
Post Code

Home Telephone No.
Mobile Telephone No.

Email Address
Emergency Contact Name
Emergency Contact Telephone No.

Health Details

Have you ever used a gym or fitness equipment before? YesNo

Do you suffer from or experience any complications as a result of having had any of the following? YesNo

Heart Disorder/Disease YesNo

Circulatory, Blood Pressure Problems YesNo

Neurological Problems/Stroke YesNo

Lung/Respiratory Disease YesNo

Dizziness/Fainting YesNo

High Cholesterol YesNo

Epilepsy YesNo

Asthma YesNo

Diabetes YesNo

Cancer YesNo

Skeletal, Back, Neck, Joint, Muscle Problems YesNo

Stress, Depression, Anxiety, YesNo

Have you had any surgery, illness or accident that may affect your ability to exercise or use any piece of fitness equipment? YesNo

If you have answered yes to any of the questions above, please provide further details below:

If you consider yourself to have a form of disability, please provide further details below:

Stonyhurst College only collects data for the purpose indicated on this form and will not distribute or share this information with any third party.

GYM MEMBER WAIVER OF LIABILITY & RELEASE

Physical exercise can be strenuous and as a member of the Stonyhurst Sports Centre, you can be subject to risk of serious injury. The Stonyhurst Sports Centre urges you to obtain a physical examination from a doctor before using any exercise equipment of participating in any exercise activity.

Members (each client, guest, and all participating family members) agree that if they engage in any physical exercise or activity, or use any gym amenity on the premises or off premises, including any sponsored gym event, you do so entirely at your own risk. You as the member agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness, or death. We are also not responsible for any loss of your personal property.

This waiver and release of liability includes, without limitation, all injuries which may occur as a result of:
1) Your use of all amenities and equipment in the facility and your participation in any activity, class, program, personal training or instruction
2) The sudden and unforeseen malfunctioning of any equipment
3) Our instruction, training, supervision, or dietary recommendations
4) Your slipping and/or falling while in the building, or on the premises
5) Contact with other participants
6) The effects of the weather, including high heat and/or humidity; and all other such risks being known and appreciated by me

By signing this waiver, you expressly acknowledge:

  • Your responsibility in communicating any physical and psychological concerns that might conflict with participation in activity
  • That you are physically fit and mentally capable of performing the physical activity I choose to participate in
  • You expressly agree to release and discharge the gym, and all affiliates, employees, agents, representatives, successors, or assigns, from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the gym for personal injury or property damage
  • To the extent that statutory or case law does not prohibit releases for negligence, this release is also for negligence on the part of the facility, its agents, and employees.

If any portion of this release from liability shall be deemed by a court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect, and the offending provision of provisions severed her from.

By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.

TERMS AND CONDITIONS

  • All members, including staff of Stonyhurst College, must complete a membership registration form prior to using the Sports Centre facilities. All employees of Stonyhurst College must supply a form of staff ID in order to acquire membership of the fitness facilities.
  • Gym membership is only available from the age of 16 and above. Proof of age may be required.
  • Members will be issued with a membership card upon signing this form, which they will require to access the facilities.
  • No filming or photography will be allowed inside the Stonyhurst Sports Centre facilities, including the swimming pool, fitness suite or studio and the tennis dome.
  • For the safety and security of our members, CCTV is in operation inside the facility.
  • Members should use the equipment and facilities in accordance with the advice given by staff or suitably posted notices. Any damage to equipment shall be paid for by the member.
  • The fitness facilities at Stonyhurst Sports Centre are a shared facility with senior College pupils. Therefore an appropriate level of conduct is expected from members and pupils alike. Disorderly, rude or inappropriate behaviour will not be tolerated and may lead to expulsion from the centre. If you have any concerns please speak to the Sports Centre Manager.
  • Due to the shared nature of the facility with students of Stonyhurst College, on limited occasions, the changing rooms may not be available to members. Please see a member of staff for details of the changing room availability and we kindly ask for your patience during these times.

I agree to the above