Personal Details

    Date of Birth:

    Address


    Contact Details


    Membership Type

    Preferred Payment Method:

    Dual Membership?

    NoYes

    Linked Member Full Name

    Are you a member of staff at Stonyhurst?

    YesNo

    Health Questionnaire

    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?

    Please tick all that apply:

    Heart Disorder/DiseaseCirculatory, Blood Pressure ProblemsNeurological Problems/StrokeLung/Respiratory DiseaseDizziness/FaintingHigh CholesterolEpilepsyAsthmaDiabetesCancerSkeletal, Back, Neck, Joint, Muscle ProblemsStress, Depression, Anxiety

    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:

    Emergency Contact Details

    Contact Telephone No.
    Contact Email Address

    Terms and Conditions

    Stonyhurst College only collects data for the purpose indicated on this form and will not distribute or share this information with any third party unless in case of a medical emergency, in which case, information may be shared with medical staff where appropriate.

    For more information on how we look after your personal information, please read our Privacy Notice, which you can find on our website.

    We will need to contact you via email and telephone with important information regarding your membership and any changes to the Sports Centre operating procedures and opening times.

    Please select the box if you are happy to receive communications regarding Sports Centre offers and news.

    YesNo