Penrith
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Penrith
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CONTACT DETAILS & DIRECT DEBIT REQUEST

Please fill out your contact form

Pre-Exercise Questionnaire

Medical Details / Considerations

It is our professional duty of care to ask all participants, no matter what age, to complete the following questions. Have you ever had or do you currently have?

  • Anyone in your family under 60 years of age suffer heart disease, stroke, raised cholesterol or sudden death?
  • Do you have any infections or infectious diseases?

If you ticked any of the above boxes, please provide details of conditions, medications and the approximate date cleared:

ACKNOWLEDGEMENT RELEASE AND ASSUMPTION

Work at an easy pace on your first visit and concentrate on learning how to do the exercise properly. On each visit, you will be able to work a little harder and with improved intensity. Be sure to limit yourself to a pace where you can still talk and breathe comfortably. Should you suffer any injury, illness or condition in the future, please tell us by completing this form again. It is recommended that all males over the age of 35 years and females over the age of 45 years should complete a medical assessment, including an exercise ECG and cholesterol/lipid count. I recognize that the instructor is not able to provide me with medical advice with regard to my medical fitness and that this information is used as a guideline to the limitations of my ability to exercise. I have answered the questions to the best of my ability and understand the advice above.
WARNING: This is an important document, which affects your legal rights and obligations. Please read it carefully and do not sign it unless you are satisfied that you understand it. If you have any questions, please ask our representative.I recognize that Fit4All is not able to provide me with medical advice with regard to my medical fitness and that this information is used as a guideline to the limitations of my ability to exercise.I have answered the questions to the best of my ability and understand the advice above. I acknowledge that the activity I am about to undertake can be dangerous and that by participating in this activity, I am exposed to certain risks. I acknowledge and understand that whilst participating in such activity;

  • I may be injured physically or mentally.
  • My personal property may be lost or damaged.
  • I may cause injury to other persons or damage their property.
  • The conditions in which the activity is conducted may vary without warning.
  • I may be injured, die or suffer damage to my property as a result.
  • There may be no or inadequate facilities for the treatment or transport of me if I am injured.
  • I assume the risks and responsibility for any injury, death or damage of property resulting from my participation in the activity.

RELEASE, INDEMNITY AND ACCEPTANCE OF TERMS AND CONDITIONS

In consideration of the acceptance of my payment for participation in the activity (and except to the extent that the same may be precluded by statute) I agree to release and indemnify Fit 4 All as follows: I participate in the activity at my sole risk and responsibility. I release, indemnify and hold harmless Fit4All, its servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by other parties for in respect of or arising out of injury, loss, damage or death caused by me or my property whether by negligence, breach or contract or in any way whatsoever. I also agree that in the event that I am injured or my property damaged, I will bring no claim, legal or otherwise, against Fit4All in respect of the injury or damage. Before signing this document, I have read and understood it and know that it affects my legal rights, I certify that the above information is true and correct. I have read and understood the TERMS AND CONDITIONS (attached) of Fit4 All PTY LTD which form part of and are intended to be read in conjunction with this membership agreement and agree to be bound by these conditions. I authorize the use of my personal information as detailed in the Privacy Act clause therein.

DIRECT DEBIT REQUEST

TAX INVOICE – PRICE IS INCLUSIVE OF GST MINIMUM 1 MONTH

STAFF ONLY:

Please use BLOCK letters and complete all details below correctly and neatly.

NAME AND BRANCH OF

TERMS AND CONDITIONS OF MEMBERSHIP

1. Periodic Memberships

  • This is a binding membership which will not be cancelled by me for the minimum term of 1 month.
  • Payments will be made on the 28th of each month.
  • All Direct Debit payments shall be payable whether or not I use the Fit 4 All facilities.
  • Fit 4 All will initiate debit items in the manner described on the front of this agreement. Payments will be made when due and no individual advice of payment will be issued by Fit 4 All.
  • Fit 4 All will provide 14 days written notice of any proposal to vary the details of this agreement including without limitation, the amount and frequency of payment. I may contact Fit 4 All about the proposed change before it takes effect.
  • Direct debiting is not available on the full range of accounts of all financial institutions and that I must check that the financial institution referred to in this agreement will accept debit under this agreement.
  • I acknowledge that it is my responsibility to have sufficient clear funds in the account to be debited when each payment is due.
  • Any change of my account details must be given in writing to Fit 4 All 14 days prior to the next debit date.
  • If a debit item is returned unpaid, I will be charged a fee of $15.00 for each such item. If my debit is returned Fit 4 All will continue to debit my account every 7 days until the amount is retrieved.
  • I will also be liable for any cost incurred by Fit 4 All to recover the outstanding amount through credit control.
  • If payment falls due on any day which is not a business day, the debit will be made on the next business day.
  • Except where disclosure is necessary to process debit items or required by law, details of your account will remain confidential to Fit 4 All.

Acknowledgement, Release and Assumption

WARNING: This is an important document which affects your legal rights and obligations. Please read it carefully and do not sign it unless you understand it. If you have any questions, please ask our representative.

I recognize that Fit4All is not able to provide medical advice regarding my medical fitness and that this information is used as a guideline to the limitations of my ability to exercise. I have answered the questions to the best of my ability and understand the advice above.

I acknowledge that the activity I am about to undertake can be dangerous and that by participating in this activity I am exposed to certain risks.

  • I may be injured physically or mentally.
  • My personal property may be lost or damaged.
  • I may cause injury to other persons or damage their property.
  • The conditions in which the activity is conducted may vary without warning.
  • I may be injured, die or suffer damage to my property as a result of negligence or breach of this agreement.
  • There may be no or inadequate facilities for treatment or transport if I am injured.
  • I assume the risks and responsibility for any injury, death or damage resulting from my participation in the activity.

Release, Indemnity and Acceptance of Terms

In consideration of the acceptance of my payment for participation in the activity, I agree to release and indemnify Fit 4 All as follows:

  • I participate in the activity at my sole risk and responsibility.
  • I release, indemnify and hold harmless Fit4All, its servants and agents, from all actions or claims arising out of injury, loss, damage or death.
  • This includes any claim resulting from negligence, breach of contract, or any other cause.
  • If I am injured or my property is damaged, I will bring no claim against Fit4All in respect of the injury or damage.

Before signing this document I confirm that I have read and understood it and know that it affects my legal rights. I certify that the above information is true and correct. I have read and understood the Terms and Conditions of Fit 4 All PTY LTD and agree to be bound by these conditions.

I authorize the use of my personal information as detailed in the Privacy Act clause included in the agreement.

WHERE MEMBER IS UNDER 18 YEARS OF AGE

BEING THE PARENT OR GUARDIAN OF THE PERSON NAMED IN THIS Membership Agreement, I GUARANTEE the due and punctual payment to Fit 4 All of all monies payable under this agreement and/or any other liability of the Member to Fit 4 All, and due observance and performance by the Member of all its obligations contained or implied in any contract with Fit 4 All, including but not limited to the Terms and Conditions and annexed to this Membership Agreement. I hereby acknowledge and agree:

  • I have read the whole of this document and understand it.
  • I consent to the member participating in the activity.
  • I am aware of the risks, dangers and obligations set out above in the acknowledgement and release.

In consideration of the person named in this acknowledgement and release being accepted to participate in the activity I agree to release and indemnify Fit 4 All in the same manner and to the same effect and extent as if I were the person first named in this acknowledgement and release and the person participating in the activity.

Our Location

Penrith
Coonabarabran
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