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Membership Form - Details
Membership Form Title
Parties To This Agreement
This agreement is executed between the below named party:
Name:
Of the below address:
Address
and you, per your details per the below input fields:
Please enter your (member) details below.
Your Name*
First Last
Avoid the use of special characters or numerical values in these name fields.
Your Email Address*
Your Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Your Contact Phone Number*
Date Of Birth*

DD
MM
YYYY
Display Fees Section?
Membership Fees
Membership Plan*
Membership Fee (£)
Payment Frequency - membership fee will be deducted each:
Display Free Trial on form?
Free Trial Value (if applicable)
Free Trial Period (if applicable)
Display Set Up Fee on form?
Set Up Fee Amount (if applicable) (£)
Display notes about fees?
Additional details of the membership fees and any associated services or products included in this agreement
Notes regarding fees go here.
Membership Terms
How many sections of terms do you want signed / initialled?
Terms
• Anyone thought to be under the influence of alcohol or drugs will be ejected and their membership will be reviewed. • If, for any reason, a direct debit payment fails to credit our account, membership may be suspended until payment resumes or another payment method is used. • For reasons of health and safety, members must adhere strictly to the following: - Suitable footwear should be worn at all times. - Offensive language or behaviour will not be tolerated. - Suitable clothing must be worn to training at all times. - Gis and or rashys must be kept clean for hygiene reasons - 1 use, 1 wash.
Sign Terms - Section 1
Terms Section 2
Test section of terms 2
Sign Terms - Section 2
Terms Section 3
Sign Terms - Section 3
Attachment(s)
This agreement requires a file to be uploaded per the below details.
Require attachment to be uploaded?
Attachment description / details
Driver's license.
Upload attachment*
Accepted file types: pdf, doc, docx, xls, jpg, png, gif, ppt.
Consent(s)
Include checkboxes
Number of checkboxes
1st Required Consent*
- Check this box
1st Consent Text
I consent to my personal details being stored as part of my gym membership.
2nd Required Consent*
- Check this box
2nd Consent Text
I consent to my gym membership fees being deducted via either Direct Debit or Credit Card payments, processed automatically on a scheduled basis.
3rd Required Consent*
- Check this box
3rd Consent Text
4th Required Consent
- Check this box
Existing Medical Conditions
Display Existing Medical Conditions?
Display specific Medical Waiver?
Details Of Any Existing Medical Conditions
Medical Waiver
You accept that any pre-existing medical conditions that may affect your ability to safely attend the gym are your responsibility to disclose and to manage, and that the gym's staff are not necessarily trained to provide medical assistance in relation to these or any other medical conditions you may experience or encounter.
Waiver
Display Waiver?
Waiver Content
You agree that you accept all liability for your own safety and well being, and that the gym takes no responsibility for any injuries or physical harm that you may experience during or as a result of training. You undertake training at your own risk with full awareness that you may injure yourself and that this is your sole responsibility and outside of the gym's control.
Emergency Contact
Require Emergency Contact?
Emergency Contact Person*
Emergency Contact Phone*
Emergency Contact Email*
Relationship*
Have You Trained Before?
Have you trained previously?*
Name of previous gym?
What belt level are you?*
How many stripes do you have?*
Approximately When Did You First Start Training?

DD
MM
YYYY
Membership Start Date
Membership Start Date*
Date Format: DD slash MM slash YYYY
Signing Area
If you are a parent / guardian or representative filling in this form on behalf of someone else, check the below box
- Yes, I am a parent, guardian or representative
Your Name*
First Last
Parent Or Guardian Name*
First Last
Your Signature*
Date*
Date Format: DD slash MM slash YYYY
Set Your Password
Please note: Once you SUBMIT this Membership Form, an account will be created for you inside our app. SET YOUR PASSWORD via the fields below. These are the login details you will use to access our app.
Membername*
Membernames can only contain lowercase letters (a-z). No special characters.
Password*
Enter Password Confirm Password

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Timestamp

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Membership Form 1 Entry
Document Description
Comments
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Membership Form - Details

Parties To This Agreement

Membership Fees

Membership Terms

Attachment(s)

Consent(s)

Existing Medical Conditions

Waiver

Emergency Contact

Have You Trained Before?

Membership Start Date

Signing Area

Set Your Password

Document Audit Trail

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