COMMON GROUNDS FITNESS

COMMON GROUNDS FITNESS

Registration & Medical History
Full Name *

First Name Last Name
Birth Date

Day Month Year
Gender *

Male Female
Phone Number *
Home
Email *
Emergency Contact *

Name
Number
Which classes are you most likely to attend?

Monday (ZUU) 5:30 PM Tuesday (Strength & Conditioning) 5:30 PM Wednesday (Ankorr) 6:00 AM Wednesday (ZUU) 5:30 PM Thursday ZUU 6:00AM Thursday (Strength & Conditioning) 5:30 PM Friday (Ankorr) 5:30 PM
Medical History
Please tick if any of the following conditions apply to you :

History of heart condition High blood pressure Ever suffered a stroke Muscle or joint injuries Diabetes Epilepsy Problems with vision or hearing Do you smoke? Currently Taking medication Allergies Experience; loss of consciousness, dizziness, vertigo or fainting Currently pregnant or had a baby in the past 12 weeks Other
Please specify (If yes to any above)
Waiver/Agreement
We love seeing our whānau push boundaries and smash goals. So often we take photo and videos to share on our social media platforms. Let us know if that is not okay with you.

Please do not share photos/ videos of me on social media I do not mind if you share photos/ videos on me on social media
Which membership would you like to sign up on? *

Individual Membership $19 Weekly Couples Membership $32 Weekly 3 Month Membership $205 ( One off payment) 6 Month Membership $410 (One off payment) 12 Month Membership $820 (One off payment) Concession Card $40 (5 Classes) Casual $10 Per Class
COMMON GROUNDS FITNESS WAIVER:

I confirm that Common Ground Fitness will not be held responsible in any way for any injury or medical issues I may experience during or after training sessions I have attended. By ticking "I agree" below, I acknowledge that I DO NOT hold Common Grounds Fitness and/or the trainer responsible for any injuries that may occur when I participate in a training session. I also confirm that I have read and completed the Common Grounds Fitness health screening correctly, honestly and to the best of my knowledge. I have read and agree to the above disclosure statement.
*

I agree
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Medical History

Waiver/Agreement