Online Form - FITNESS Membership

The Shire of Coolgardie offers a gym in each town site of  Coolgardie and Kambalda.

Please click here for full terms and conditions

MEMBERSHIP GYM FACILITY*
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MEMBERSHIP COOLING-OFF PEROID

Client may terminate their membership within 7 days; after the day on which the client enters into the agreement. Administration fees will apply at a pro rata rate to the term of agreement.

FITNESS MEMBERSHIP TYPE

Casual Entry
FITNESS Monthly
FITNESS Flexi
FITNESS Active
Special Membership
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Have you been a gym member before?*
Is a new FOB, required? (This will be an additional cost) *

EMERGENCY CONTACT DETAILS

PRE-EXERCISE SCREENING

Has your Doctor ever told you that you have a heart condition or have ever suffered a stroke?*
Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?*
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise? **
Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise? **

AGREEMENT TERMS AND CONDITIONS

I declare, to the best of my knowledge that all of the information I have provided is complete and correct.

I understand that IF I answered YES to any of the 7 questions above, I should seek guidance from my GP or appropriate allied health professional prior to undertaking Physical Activity / Exercise at the Shire of Coolgardie Gym Facilities and that I require a medical clearance to be eligible to receive an exercise program prescribed to me by a qualified gym instructor.

I declare that I am medically and physically able to participate in physical activity, and understand and accept the inherent risks of undertaking exercise. 

I acknowledge and agree that I enter the Facility and surrounds and/or participate in programs, utilise the equipment and/or take advantage of services offered by Shire of Coolgardie absolutely at my own risk .

AGREEMENT TERMS AND CONDITIONS