Gym Membership Application Form

GYM APPLICATION FORM
Name:
Home Address:
Date of Birth:
Home Phone#: Cell #:
National Identification Document: ID Card Drivers Permit Number
Email Address:
Position/Title (employees):
Referred by (Employee):
Dates of Vaccination
Emergency Contact Name: Phone #:
Medical Issues/Conditions:
Signature of Applicant Date

This Membership Agreement for the type of membership indicated below is between UDeCOTT Health
and Wellness Committee and the undersigned applicant.
PAYMENT OF MEMBERSHIP FEES (Upadnas)
Upon approval of membership by the Health and Wellness Committee, Gym Membership Fees become
due and payable and shall be paid prior to use of the Gym and its amenities.
Transferability
Memberships are not transferable and cannot be frozen.
Termination of Membership
Termination of Upadna Membership
In instances of non-compliance with the rules and the regulations of the Gym, the membership of a
Upadna may be terminated without a refund of any Membership Fee paid or any part thereof, and/or
may be banned from using the Gym and its amenities for a period of one (1) to three (3) months as
determined by the Health and Wellness Committee, which shall take into consideration the nature and
seriousness of the offending act. Consistent and serious non-compliance may result in an indefinite ban.
Termination of Employee Membership
Non-compliance with the rules and regulations of the Gym, may result in termination of employee
membership or may result in a ban on the use of the Gym and its amenities for a period of one (1) to three
(3) months, based on the nature and seriousness of the offending act. Consistent and serious non-
compliance may result in an indefinite ban and may, depending on the nature of the act, attract the
Disciplinary Procedures and Policy of UDeCOTT applicable to its Employees.
WAIVER OF LIABILITY
In consideration of my use of the Gym and its amenities, I expressly agree and contract, on behalf of
myself, my heirs, executors, administrators, successors and assigns, that UDeCOTT and its insurers,
employees, officers, directors, and associates shall not be liable for any damages arising from personal/
bodily injury (including death) sustained by me, in or about the Gym and its amenities or arising from the
use of the equipment, regardless of whether such injuries result in whole or in part from the negligence
of UDeCOTT.
I further agree to indemnify and hold UDeCOTT harmless against any and all claims, demands, damages,
rights of action, or causes of action, that may arise out of my use of the Gym and its amenities, and further
agree to comply with all rules imposed regarding the use of the Gym as set out hereunder.
I acknowledge that the use of any exercise equipment, engaging in exercise and physical exertion may
result in and involves the risk of serious injury including death and disability. I warrant that I am in good
physical condition and have sought the necessary medical advice prior to the use of the Gym.
I also understand and agree that UDeCOTT is not responsible, and shall bear no liability for property
personal or otherwise that is lost, stolen or damaged while in or about the Gym.
GYM RULES
Members are required to adhere to the following rules:
a. Present membership cards or employee IDs at the front desk;

b. Sign the attendance register upon entry and departure of the Gym;
c. Treat the Gym Service Provider (any other staff and service providers) with respect and respond
appropriately to all reasonable requests;
d. Refrain from tampering with, damaging or vandalizing Gym fixtures and equipment;
e. Store water or sports drinks for consumption in sealable bottles;
f. Use a towel while in the Gym;
g. Adhere to strict personal hygiene standard;
h. Sanitize and wipe equipment after each use;
i. Place weights in their designated areas after use;
j. Adhere to the Gym Dress Code;
k. Place and store personal items in lockers;
l. Remove personal items from lockers and washroom areas after sessions;
m. Cardio machines are restricted to fifteen (15) minutes of use per user subject to machine
availability;
n. Place cell phone on vibrate, and utilize same for listening to music (with headphones), and as a
fitness tracker;
o. Refrain from playing loud personal music in the Gym and utilize personal radio/music devices
outfitted with earphones;
p. Refrain from the non-consensual recording, filming, photographing and documentation of other
Members, and other personnel in the Gym and its amenities. Any such recording, filming,
photography and documentation may be undertaken by UDeCOTT for a purpose approved by the
UDeCOTT Health and Wellness Committee, in which case Members shall be so notified and the
necessary consent obtained;
q. Refrain from bringing children into the Gym and its amenities;
r. Adhere to all safety instructions/precautions while using equipment;
s. Report all defects of the Gym including facilities, equipment immediately to the Gym Service
Provider;
t. Report all incidents/accidents immediately to the Gym Service Provider;
u. Be respectful, courteous and considerate to each other;
v. Be considerate of the length of time spent using a particular piece of equipment;
w. Refrain from loitering in the Gym;
x. Refrain from engaging in vulgar behaviour, language or excessively loud laughter in the Gym,
Locker room or washroom areas;
y. Adhere to the COVID-19 protocols (entry temperature-screening, hand-sanitizing and mask-
wearing); and
z. Harassment in any form is strictly prohibited at the Gym.
The undersigned states that he/she has read the Rules and Regulations of the Gym set out below
and has agreed to be bound by same.
APPROVAL BY THE HEALTH AND WELLNESS COMMITTEE
Applicant’s membership is subject to approval by the UDECOTT Health and Wellness Committee and upon
submission of valid proof of COVID-19 Vaccination. It is recommended that persons desirous of
membership obtain clearance from their Physicians prior to using the Gym and commencing an
exercise program. Members warrant that they are in good physical condition and have obtained the
necessary clearance and medical advice. Where a member is suffering from an illness, injury or long
term medical condition, and has not visited a fitness facility or gym in excess of six (6) months, as a
result of illness or injury, a Medical Certificate from a Physician is required, and will be kept on record.
Signature of Applicant Date
________________________________________________________________________________
FOR OFFICIAL USE ONLY
Medical Certificate submitted ☐ Yes ☐ No
National Identification Document submitted Yes No
APPROVED BY
Name (Block Letters) Signature
ID#/Employee # Date

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GYM APPLICATION FORM

Home Phone#: Cell #:

National Identification Document: ID Card Drivers Permit Number

Emergency Contact Name: Phone #:

Signature of Applicant Date

PAYMENT OF MEMBERSHIP FEES (Upadnas)

Memberships are not transferable and cannot be frozen.

Termination of Upadna Membership

Termination of Employee Membership

Members are required to adhere to the following rules:

a. Present membership cards or employee IDs at the front desk;

Signature of Applicant Date

FOR OFFICIAL USE ONLY

Medical Certificate submitted ☐ Yes ☐ No

National Identification Document submitted Yes No

Name (Block Letters) Signature

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