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MEMBER REGISTRATION FORM

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MEMBER REGISTRATION FORM


Emergency Contact:




Medical Questionare


1. Have you ever or do you have any of the following ?
2. Do you have any problems/injuries in the follow areas? (please tick and explain to the best of your ability):


ACKNOWLEDGEMENT RELEASE AND ASSUMPTION OF RISK

Warning: This is an important document, which affects your legal rights and obligations. Please read it carefully and do sign it unless you understand it. If 'you have any questions, please ask.

Acknowledgment of Risks, Injury and Obligations

I ncknowledgc that the ucli\;iliejs Irzm to undellmke have potential dangers and by participating in them I am exposed to certain risks. Tacknowledge and understand that whilst participating in any such activities:

  • I may be injured physically, mentally or may die.
  • Any physical conditions I may have, of which I may or may not be aware of, which I may or may not have disclosed to the centre or its stafY, may be aggravated or worsened by my participation;
  • My personal property may be lost or damaged;
  • DOther persons participating in such activities may cause me injury or may damage my property;
  • may cause injury to other persons or damage their property;
  • The conditions in which the activities are conducted may vary without warning;
  • I may 5 be injured or die or suffer damage to my property as a result of negligence or breach of contract of the Fitness Centre operator, or its servants or agents; and There may be no or inadequate facilities for treatment or transport of me if I am injured.
  • assume the risk of, and the responsibility - . any activities. for any injury, illness, death or property resulting from my participation in any activities.
Release and Indemnity to Dance & Fitness Studio

In the consideration of the acceptance of my payment (or guest status) for participating in any activity (except to the extent that the centre may be precluded statute) I agree to release and indemnify the Dance & Fitness Studio and staff as follows :

  • I participate in the activities at my sole risk and responsibility; and

Before signing this document, I have read and acknowledged and know how it affects my lcgal rights.

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WHERE PARTICIPANT IS UNDER 18 YEARS OF AGE

(Parent/ Guardian to read and sign)

I, being a parent or legal guardian of the person named in this Acknowledgement and Release hereb y acknowledge and agree:

  • have read the whole document and understand it;
  • I consent to the person, named in this Acknowledgement and Release, participating in the activity; and
  • I am aware of the risks, dangers and obligations set out above in this Acknowledgement and Release.

In consideration of the person named in the Acknowledgement and Release being accepted to participate in any activity, agents, in the same manner and to the same I agree to release and indemnify the Dance & Fitness Studio, its servants and effect and extent as if I were the person first named in this Acknowledgement and Release and the person participating in any of these activities.



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