Silver Gym Membership Registration Form – Welcome to Beyond Basics Fitness & Nutrition

First Name *

First

Last Name *

Last

Address

City

Province

Postal Code

Phone

Email

Birthdate

Membership Start Date

Emergency Contact Name

Relationship to Applicant

Emergency Contact Phone #

Membership Duration (2 Month Minimum)

Recurring

Pre-existing medical conditions

Additional Medical Notes

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AGREEMENT

I, the undersigned, waive all rights for myself, my heirs, successors, executors, administrators and assigns, and release Beyond Basics Fitness & Nutrition, its employees, agents, contractors and relatives, from all claims, without limitation for any and all personal injuries suffered by me as a result of my use of the Beyond Basics Gym, its’ equipment, facilities or my presence anywhere on Beyond Basics property, and participation in any event(s) or workshops within the Beyond Basics Fitness or Educational Activities on or off Beyond Basics property. I am aware that the physical exertion required of the Fitness Activities and the forces exerted on the body can activate or aggravate pre-existing physical injuries, conditions, symptoms or congenital defects. I have been advised to seek medical advice prior to participating in Fitness Activities. I have no reason to believe that my physical condition may be incompatible with such activities. I freely accept and fully assume all risks, dangers and hazards associated with the fitness activities and the possibility of personal injury, death, property damage or loss resulting therefrom. I also acknowledge that should I suffer personal injury while participating in on or off site fitness activities, that Workers' Compensaton Coverage will not apply. (PLEASE TYPE YOUR FIRST AND LAST NAME AND ADD YOUR SIGNATURE BELOW IN AGREEMENT WITH THE BEYOND BASICS GYM MEMBERSHIP CONTRACT, GYM RULES & GUIDELINES, AND WAIVER.)

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You will receive an email with further instructions once we have received your PayPal, Credit or Debit Payment. Comment below if you have any questions or would like to book a time for a tour. See You Soon!