Safety Waiver

Name*

First Last

Date of Birth*

Are you under 18 years of age?*

Directions: This is a safety waiver that must be completed before the facility can issue you your 24-hour access key. This waiver covers simple standards, procedures and responsibilities of the member and facility. Please, read the waiver and release carefully. After doing so, initial each section, sign and date at the bottom in the presence of a club representative:

Members under 16 years must be accompanied by a parent, guardian or Personal Trainer.
In addition to the above, members under 15 years are limited to cardio equipment and some classes.
Members with outstanding accounts may have restricted access to the club.
Replacement 24-hour key passes will cost $19.95.
Enclosed footwear to be worn at all times within the facility. No dirty trades clothing or boots.
Towels are to be used on equipment at all times and equipment to be correctly stored after use.
Emergency evacuation procedure, ﬁrst aid kit location and emergency devices located in hallway.
The steam rooms are only accessible during staffed hours.
The pin-coded lockers are not available outside of staffed hours. Use open lockers at other times.
No member is permitted to bring a non-member into the facility outside of staffed hours. Fines apply
Trial only: $20 deposit taken for FOB will be donated if not collected within 14 days of trial end date.

Acceptance*

I agree to this policy

You have agreed to purchase a membership at a facility that allows you access at any time. As such, you are aware that there may be no supervision or assistance. You are also aware that if you suffer an injury, such as becoming unconscious, suffering a stroke or heart attack, that there will likely be no one to respond to your emergency and this facility has no duty to provide assistance to you. Even though this facility is equipped with surveillance cameras, in the likelihood that you should require immediate or emergency assistance, none will be provided. We HIGHLY recommend that you have a workout partner accompany you while at the club, but it is not required. Having a workout partner is not a release from liability to you

Acceptance*

I agree to this policy

Physical exercise is inherently risky for serious injury. The club urges you to obtain a physical examination from a licensed physician before using any exercise equipment or participating in any exercise activity. You (each member, guest, or participant) agree that if you engage in any physical exercise or activity, or use any Club amenity on or off of the Club’s premises, including any sponsored Club event, you do so entirely at your own risk. You agree that you are voluntarily participating in the use of this facility and assume all risks of injury, illness, or death. The Club shall not be held responsible for any loss or damage to your personal property.

Acceptance*

I agree to this policy

This waiver and release of liability includes, without limitation, all injuries which may occur, regardless of negligence, as a result of; (a) your use of all amenities and equipment in or about the facility, (b) your participation in any activity, class, program, personal training or instruction, (c) the malfunctioning of any equipment and/or (d) your slipping and/or falling while in or about the Club, including adjacent sidewalks and parking areas.

Acceptance*

I agree to this policy

You acknowledge that you have carefully read this "waiver and release" and fully understand that it is a release of liability. You expressly agree to release and discharge the Club, and all afﬁliates, employees, agents, representatives, successors, or assigns of the Club, from any and all claims or causes of action. You agree to voluntarily waive any right that you may otherwise have to bring a legal action against the Club for negligence, either by omission or commission, personal injury or property damage or other tortable acts

Acceptance*

I agree to this policy

PRE-EXERCISE MEDICAL SCREENING TOOL

This screening tool does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualiﬁed medical professional. No warranty of safety should result from its use. The screening system is no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Prulec Pty Ltd T/A The Gym Glenelg for any loss, damage or injury that may arise from any person acting on any statement or information contained in this tool.

1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*

YES
NO

2. Do you ever experience unexplained pains in your chest at rest or during physical activity*

YES
NO

3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*

YES
NO

4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*

YES
NO

5. If you have diabetes (Type I or Type II) have you had trouble controlling your blood glucose in the last 3 months*

YES
NO

6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?*

YES
NO

7. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*

YES
NO

If you answered “YES” to any of the above 7 questions, please seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/exercise.

If you answered “NO” to all of the above 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.

I believe that to the best of my knowledge, all of the information I have supplied above is correct.

Note Should any part of this agreement be found by a court of law to be against public policy or in violation of any state statute or case precedence, then only that wording shall be removed and the remainder of this agreement shall remain in full force

Member Name*

Member Signature*

Guardian Name (if member is under 18 years of age)

Guardian Signature (if member is under 18 years of age)

CAPTCHA

PRE-EXERCISE MEDICAL SCREENING TOOL