Membership Form

Name:
Address Line 1:
Address Line 2:
Landmark: City: State: Pin-Code:
Contact Details (Landline): Mobile:
Email Address:
Date of Birth: Age: Gender:MaleFemale
Height: Cms | weight: Kg
Occupation:
Company (Firm Name):
Type of work: Physical WorkDesk WorkField WorkTravellingAny Other
Emergency Contact Person name: Contact Number:
Doctor's name: Contact Number:
How do you come to know about 'O2 Fitness Gym?' NewspaperInternetFriendPamphletHordingOther

Medical Information (if 'YES' for any option bellow, please explain)

1) Has your Dr. any time restricted you from any Physically Heardwork activity?NoYes
2) Do you Smoke?YesNoOccasionally
3) Do you consume alcohol? YesNoOccasionally
4) Are you currently taking any medication? (Please Specify)NoYes
5) Do you know any other reason, you should not to do any physical activity?NoYes
6) Any history of Heart problem ?NoYes
7) Increased Blood Pressure?NoYes
8) Difficulty in physical exercise?NoYes
9) Surgery or hospitalization (last one year)? NoYes
10) Pregnancy (Now or within last three months)?NoYes
11) History breathing or lung problems / asthma? NoYes
12) Muscle / joint (knee, neck, ankle, etc.) disorder still affecting you?NoYes
13) Diabetic condition?NoYes
14) Thyroid condition ?NoYes
15) Over Weight (more than 20% over than ideal weight ?)NoYes
16) High Cholesterol? NoYes
17) Hernia or any condition that may be aggravated by doing strenuous activity?NoYes
18) Epilepsy condition? NoYes
19) Interested in pick-up & drop facility?NoYes
20) Are you socially active?NoYes| Mark if any FacebookInstagramTwitterYouTube

Interested in:

GymPersonal Fitness TrainingPerformance Fitness TrainingProfessional BodybuildingSpecial Population Training For Physically Challenged PeopleAdvances CardioFunctional TrainingZumba DanceCrossfitYogaPower YogaStrength Training

Disclaimer:

A small risk exist while performing any form of exercise, latent health problems or weakness may become apparent and could conceivably lead to injury in such case. This is also true in respect of use of exercise equipments in “O2 Fitness Club” exercise program.
Any person who:
1. Has a known medical condition might be adversely affected by exercise, or
2. Has habitually taken no form of exercise before, or
3. Has no reason to believe that health problem or weakness may exist, or
A Person must seek medical advice in any of the above situation...
Anyone who under take exercise against the medical advice of the doctor shall do so at their own risk and “O2 fitness club” shall not be held responsible in the event of any illness or death which may result.

I have read and understood the above and have taken any action required.

Terms and Conditions for Fees and Payments:

• Fees once paid will be not Refundable at all.

• Fees should pay on given date even if the sessions are missed out. The renewal date will remain same even though the payment is late. Late payment is not acceptable and has to pay penalty as Rs.50/- per day.

• Cheque payment must be made on 3 days before the renewal date else previous date is consider as renewal date, not the clearing date.

• Half payment of the fees is not acceptable at all; fees must be paid in full.

• Management has right to make alteration in fees structure and will inform accordingly. Do not bargain with the charges.

• Members are allowed on the floor only after the payment is done.

• Modes of payments are Cash/Cheque/E-payment.

I agree to the Terms and Conditions

Member’s Name:
Member’s Signature:

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