GYM MEMBERSHIP FORM – Brana Eagles Fitness Center

Name

Member No.

Tel No.

Sex

Male Female

Age

Weight

Person to contact incase of emergency

Do you have history of heart attack or stroke?

Yes No

Do you sometime feel pains in the chest?

Yes No

Do you have blood pressure related problems?

Yes No

Are you currently under medication?

Yes No

Are you asthmatic?

Yes No

Are you diabetic?

Yes No

Do you have muscle joint injury or any major injury in the past year still affecting you?

Yes No

Do you smoke?

Yes No

Are you pregnant?

Yes No

If YES, how many months pregnant?

Do you sometimes feel dizzy or faint?

Yes No

Do you regularly participate in any physical activity?

Yes No

If YES, what type/regiment?

Please state the reason for exercising. Tick where appropriate.

Do you have any medical condition/history you have not disclosed?

Yes No

If YES, What is the medical condition?

PAYMENT POLICY : - • No Refund Policy. Once fitness center membership is purchased, there will be no refund. Thus, clients are advised to make an informed decision while making a purchase on our gym and health clubs.
• Membership once purchased is not transferable.
• Please note that decision on any refund and cancellation policy shall be final and binding.
• Cancellation or termination of gym membership, your previous fees will not be refunded

I hereby give permission to Brana Eagles Fitness Centre to photograph, videotape / film and to use my image in photographs, motion pictures, film and or any multimedia format on any public or private platform thereof for the purpose of promoting the activities and programs of Brana Fitness Centre. I understand that I am not entitled to any compensation or rights in these materials and I release Brana Eagles Centre or any of its agents from any liability for the use of my image for above –stated purposes.

I declare that the information I have given above is correct and understand that I use Eagles Brana Fitness at my own risk and that I will undertake exercises only in accordance with the safety guidelines and the instructions only from authorized personnel. I further undertake to indemnity staff and management from any action arising from any injury that I might incur as a result of non-disclosure or partial disclosure of details concerning my health while participating in this program.

Date

Membership Sign-Up Form

BRANAEAGLES FITNESS GYM MEMBERSHIP FORM

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