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Indoor Cycling
Ante/Post Natal
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Registration Form
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Home
Mat Pilates
Reformer Pilates
Group ETM
Indoor Cycling
Ante/Post Natal
Step
Contact Us
Learner Registration Form
Complete and submit our registration form
Certain fields are required, please fill in as much of the form as possible.
Some fields are required.
Your Information
Your first name is required
Your surname is required
Your address is required
Your post code is required
Your date of birth is required
Your email is required
Male
Female
Your gender is required
English as 2nd language
Fitness Declaration and Safety Agreement
History of heart problems
Yes
No
This field is required
Epilepsy, seizures etc
Yes
No
This field is required
Back problems
Yes
No
This field is required
Joint problems
Yes
No
This field is required
Asthma, breathing or lung problems
Yes
No
This field is required
High blood pressure
Yes
No
This field is required
Recent surgery
Yes
No
This field is required
Learning difficulties
Yes
No
This field is required
Physical disabilities
Yes
No
This field is required
Language difficulties
Yes
No
This field is required
If yes to any of the above, enter details.
Person to contact in case of emergency
Your emergency contact name is required
Your emergency contact number is required
Payment
Method of payment:
Full payment
Instalments
Deposit
Method of payment is required
Amount Paid is required
Date of payment is required
Declaration
I declare to the best of my knowledge that I know of no reason why I should not participate in Exercise classes. I acknowledge that there are risks inherent in physical exercise. I agree to abide by the verbal or written instructions given to me by the Tutor and will observe any written notices regarding safety whilst training.
Confirm
Declaration must be confirmed
Todays Date is required
Submit
Clear
YMCA Approved and CIMSPA Endorsed
