Sign up & Waiver Form | The Iron Works Gym

First name

Last name

Full Address

Contact Number

Date of Birth required

Emergency Contact Name

Emergency Contact Phone

Has your doctor advised that you should not participate in physical activity or exercise? Required

Yes

Are you pregnant or postnatal? Required

Yes

N/A

Do you suffer with asthma or breathing difficulties? Required

Yes

Have you been in hospital in the last 3 years? Required

Yes

Are you currently taking any medications? Required

Yes

Do you suffer with diabetes or epilepsy? Required

Yes

Do you suffer from an allergy? Required

Yes

Has your doctor ever said that you have a heart condition and that you should only participate in physical activity recommended by a doctor? Required

Yes

Do you feel pain in your chest when you do physical activity? Required

Yes

In the past month, have you had any chest pain when you were not doing any physial exercise? Required

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness? Required

Yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity? Required

Yes

Is your doctor currently prescribing drugs for your blood pressure or a heart condition? Required

Yes

Do you know any other reason why you shouldn't participate in physical activity? Required

Yes

If you answered YES to any of the above questions, please provide more information:

Height

Weight

Age

I understand the rules and regulations to train at The Ironworks Gym and I will train in a safe and respectful manner. I will not put myself or any other member at risk of harm or injury. I confirm I do not suffer from any undisclosed illness or injury. I understand that if I am under the ages of 18, I have parental permission to in at this facility unsupervised. I understand that I will not leave any personal possessions on site and agree that my belongings may be disposed of if left. Training is at my own risk. The Ironworks Gym will not be responsible for any injury sustained.

I confirm I have read and agree to the terms & conditionsView & Read T&C's & Waiver

Your Signature

I declare that the info I’ve provided is accurate & complete

I understand that all the information given is correct and to the best of my knowledge. I am in good health and not knowlingly incapable of engaging in either active or passive exercise and that such exercise would not be detrimental to my health, safety, comfort, wellbeing or physical condition. I understand that the facility cannot accept liability for the loss of property or injuries sustaine whilst on the premises. A small risk always exists when taking any form of exercise and that a health problem or weakness may become apparent and could conceivably lead to injury, illness or fatality. It is strongly recommended that I should refer to my GP for advice before starting training. I agree to inform the staff of any changes to my health if they occur. We do not accept any persons who have unspent and or spent convictions for any sexual offence and those who have been or who are currently on the sex offender register.

Thanks for submitting!

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SIGN UP FORM & MEDICAL WAIVER