Fitness Suite Membership Application - Reading Blue Coat School Reading Blue Coat School

RBC Gym Membership Application Form

• Please note, it is important that the PAR-Q is completed and signed as well as the terms and conditions of the contract by each member of your family who would like to use the facilities.
• All gym members are required to undergo an induction before using the gym.
• The minimum age for members is 16 unless approved by the Gym Manager.

Thank you for taking time to complete your application carefully and we look forward to welcoming you to our new Reading Blue Coat Fitness Suite.

Name*

Title

First

Last

Date of Birth*

dd/mm/yyyy

Address*

Street Address

Address Line 2

City

County

Postcode

Country

Mobile phone number*

Email address*

Do you declare a disability?*

If yes, please specify.

Emergency Contact Details

Please list the details of a reliable emergency contact.

Name of Emergency Contact*

First

Last

Relationship

Phone Number of Emergency Contact*

Membership

Membership Type*

Please indicate the type of membership you require by ticking the relevant box.

Membership Plan*

The boxes below refer to the time at which you become a member - please indicate in which time period you are making your membership application. All memberships will need to be renewed in September 2020.

Payment Details

Standing Order or BACS payment to be set up by members. Please contact the RBC Finance Department for further details (finance@rbcs.org.uk).

Declaration*

I confirm that my details are correct and I will notify the Reading Blue Coat Sports Facilities Manager is my details change at any time.

Members Under 18

The person making this application is under 18 or unable to sign themselves. I confirm that I will be taking responsibility for this person’s declaration. If you are over 18, and filling this form in for yourself, please skip this section and go straight to the PAR-Q section.

Name

First

Last

If you are filling out this form on behalf of someone who is Under 18, or cannot complete the form themselves, please enter your own name.

Relationship

Please describe your relationship with the person applying for membership.

Confirmation

I confirm that the details submitted are true of the person applying for membership at the Reading Blue Coat Fitness Suite.

Please confirm that the details of the person applying for membership at the Reading Blue Coat Fitness Suite are correct at the time of completing this application.

IMPORTANT - DATA PROTECTION

Reading Blue Coat School collects and processes information about Sports Facilities members. The Data Protection Act 1998 requires Reading Blue Coat School to obtain your agreement before this can be done. In signing this form you are giving consent for your personal and sensitive information to be processed under the rules and safeguards laid down by the 1998 Act. Reading Blue Coat School has procedures in place to ensure that all information held about you will be dealt with confidentially, held securely and only processed in accordance with Reading Blue Coat School’s notification to the Information Commissioner, who administers the Act. Reading Blue Coat School will not contact you for marketing purposes, and you will only be contacted to discuss your membership or details of your application or declaration.

Physical Activity Readiness Questionnaire (PAR-Q)

Questionnaire*

1. Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had a chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing medication for your blood pressure or heart condition?
7. Do you know of any other reason why you should not do physical activity
8. None

If you are between the ages of 16 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide when answering these questions. Please tick any question to which your answer is 'yes'.

Further Information

If you answered 'yes' to any of the above questions, please provide more information.

If you answered 'yes' to one or more questions you should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

All Users

I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. I understand that use of the RBC Fitness Suite is at my own risk.

Name

First

Last

Date

Email