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Deadlift Day - WORLD GYM BUNDABERG

ADULT PRE-EXERCISE SCREENING TOOL

Todays Date

Name*

First Last

I wish to (payments collected on day):*

Participate in Deadlifts ($20)

Participate and T-shirt ($45)

Plank - $20

Watch and show my support

I wish to (payments collected on day):

Participate in the Deadlift for Harry Event - $20

Watch and show support donating - $20

Watch and show support, donating your amount

Your amount*

Mobile*

Gender*

Male

Female

Weight Category*

Weight Category Female*

My body weight is*

My Maximum Deadlift Weight is*

Email*

Medical Waive

This screening tool does not provide advice on a particular matter, nor does it subsitute for advice from an appropriately qualified Medical Professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by World Gym, Exercise and Sports Science Australia, Fitness Australia or Sports Medicine Australia for any loss, damage or injury that may arise from any person acting on any statement or information contained in this tool.

STAGE 1

AIM: To identify those individuals with a known disease, or signs or symptoms of disease, who may be at a higher risk of an adverse event during physical activity/exercise. This stage is self administered and self evaluated.

1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*

Yes

If yes - please describe:*

2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?*

Yes

If yes - please describe:*

3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that cause you to lose balance?*

Yes

If yes - please describe:*

4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*

Yes

If yes - please describe:*

5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose for the last 3 months?*

Yes

If yes - please describe:*

6. 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?*

Yes

If yes - please describe:*

7. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*

Yes

If yes - please describe:*

IF YOU ANSWERED ''YES'' to any of the 7 questions, please seek guidance from your GP or appropriate allied professional prior to undertaking physical activity/exercise

IF YOU ANSWERED ''NO'' to all the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.

World Gym Bundaberg Rules and Regulations

Consent*

I agree to the following rules and regulations:

These Rules and Regulations are in place to ensure that we protect the rights of the members and ensure that you can achieve your results in a pleasant, motivating and non judgemental environment.

• COVID – All members are to keep to 1.5mtrs physical distancing when directed.
• COVID – Practice good hand hygiene, clean and disinfect your environment.
• COVID – Members are to stay at home if you unwell and / or have any symptoms of the virus.
• Members MUST sign in with their key tag on arrival.
• Members must wear covered foot wear and clean respectable, gym attire. At the discretion of World Gym Management. Jeans or clothes which can tear upholstery NOT allowed. No dirty workwear allowed.
• Bags NOT permitted on gym floor.
• Towels must be used at all times when using equipment and stretch area.
• Sexual or racial harassment or harassment or intimidation of any kind will not be acceptable.
• Profanity, excessive noise, excessive grunting or yelling will not be acceptable.
• Theft or Drug Dealing of any kind will be reported to the police.
• Dropping of weights and banging machines is not allowed. Treat equipment with respect otherwise membership can be terminated.
• It is a requirement of your membership and a courtesy to others that all weights, plates, dumbbells, barbells and other equipment used, shall be returned to its rack, stand or place of origin after use.
• All members must respect the staff and other members, and be courteous of their rights and privileges while in the facility.
• Entering the facility under the influence of alcohol or drugs is strictly prohibited.
• Partaking in any illegal action or activity within the World Gym Boundaries including the car park is strictly prohibited.
• Spitting, vandalism or unruly behaviour will not be permitted.
• You are NOT permitted to bring any non-members into the Club during unstaffed hours, or let anyone else use your 24/7 keytag at any time otherwise fines and cancellation of membership will apply.
• Only World Gym licensed personal trainers are permitted to train or coach members within the Club. Anyone found doing this will be asked to leave gym immediately.
• Pin coded lockers in change rooms are only to be used for the duration of your training session. Every night the lockers will be cleaned out and items thrown away.
• Smoking including e-cigarettes is strictly prohibited in all areas of the gym.
• Certain areas will be locked and unaccessible during unstaffed hours. These include
-Sauna, Steamroom & Monsoon Shower (Relaxation Area), Rock Climbing Wall , Pool,
Supplement Shop & Café and behind reception or any staff only area.
• Selling of supplements, foods, drinks, merchandise products by any members or staff not approved by Club Manager on World Gym Bundaberg Property is strictly prohibited.
• Children or members under the age of 16 cannot use Club during unstaffed hours and they must be accompanied by an adult during normal staffed hours. All children who are not members of the gym must be admitted into Kidsworld upon entry.
• Members are solely responsible for their own belongings while training at World Gym Bundaberg. Phoenix Health Clubs Pty Ltd accepts no responsibility for any loss or damaged personal property.
• Report any broken or damaged equipment to staff at reception.

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Consent

With regard to World Gym Reformers/HIIT Membership T/C

TERMS AND CONDITIONS
By agreeing to participate in our classes, you agree to be bound by our Terms and Conditions set out below (Terms and Conditions).
If you do not agree with any of these Terms and Conditions, please do not participate in our classes.
We reserve the right to change, update or reissue these Terms and Conditions at any time. Any such changes will be available to see our website and you agree to be bound by such changes.

1. Medical Warning
Prior to undertaking any new form of exercise, you should consult your doctor or other healthcare practitioner to ensure that you are mindful of your current health and any restrictions that may be appropriate for you.
When participating in our classes, do not over-exert yourself and work at your own pace.
Stop immediately if you feel pain or discomfort.
You should immediately seek medical attention if there are any unanticipated changes to your physical condition at any time.
You must notify your Group Fitness Instructor if you have any pre-existing injuries or medical conditions which may impact upon your ability to perform the exercises in our classes.
By undertaking any exercise program, you acknowledge that you do so at your own risk that that the instructors will not be liable for any personal injury, loss or liability of whatsoever nature arising as a result of, or in connection with, your undertaking of any such exercise program or following advice contained on our website or given by our instructors.

2. Prices and Booking
Our current prices and timetables are displayed on our website and found at reception.
To sign up to participate in our classes, you must book using the World Gym Yep Booking System. Your account will be governed by these terms and conditions, our Website Terms of Use, and our World Gym Privacy Policy.
There are a set number of bookings available in each class. To attend, you must reserve your spot by booking your class. Bookings can be made online 1 Week in Advance or by calling reception during staffed hours.

3. Cancellation Policy for Reformer Classes Only
To cancel a booking, you must notify us at least 12 hours prior to the commencement of the class. Cancellations made with less than 12 hours-notice will incur a fee of $15.
Class bookings can be cancelled online by logging into your account and choosing to unreserve the class you wish to cancel, or by calling or emailing World Gym Bundaberg.

4. Class Waitlists for Reformer Classes Only
No availability in a class? No problem! If you are unable to book a spot because the class is full, register yourself on the waitlist. When a spot becomes available, you will be notified via email and automatically booked in. Please ensure you check your email for your waitlist confirmation.
(As a courtesy, if you are no longer available to attend the class, please remove yourself from the waitlist. Once you have been confirmed in the class from the wait list, our 12 hour courtesy policy applies and a cancellation fee will apply if cancelled within this time).
5. Class Schedules
Class Schedules are subject to change or cancellation without notice.
We are not liable in any way to provide you with a refund, credit, transfer or compensation of any kind for classes that are not held in accordance with the class schedule, including without limitation any classes that are changed or cancelled.

6. Conditions of Entry for Reformer Classes
We recommend you aim to arrive at least 5 minutes prior to the scheduled commencement time of a class. Once the class has started, your reformer may be given to someone on the waitlist.
Clients are strongly discouraged from departing classes prior to their scheduled conclusion time as it is disruptive to the enjoyment of other students attending those classes
You are required to treat all persons and property with all due care and respect.
Students are required to wear appropriate attire within the studio.
For hygiene purposes, socks must be worn at all times during your workout. A water bottle and towel is compulsory to use any World Gym equipment.
Reformer grip socks are available for purchase from reception.

7. Personal Safety and Acceptance of Risk
You must inform instructors if there are any risks to your health by participating in Reformer. You must advise your instructor of pre-existing injury, illness, muscle soreness/discomfort or are pregnant, prior to commencement. Participating in any form of exercise with a Medical Condition is done entirely at your own risk. A medical pre-screen must be completed prior to attending classes and updated at your own discretion if this changes.

8. Pregnancy
Our regular classes are safe for women to attend up to 14 weeks of pregnancy. Once pregnancy reaches 14 weeks, it is required that you stop attending the standard classes.
Specialty Pregnancy Workouts may be offered at certain times. These speciality Pregnancy Workouts are safe for women to attend throughout their entire pregnancy up to full term, if they feel comfortable to do so.

Special Considerations in relation to WG30 Classes

• Access to the World Gym WG30 Zone is available to Platinum Members ONLY, 24 hours a day. If unauthorized members are taken into the zone, the members will be charged $20.00 on their next payment.
• During unstaffed hours, safety pendants are accessible for use. We advise to use the pendants at anytime when training in these zone’s outside of classes times.
• Access for training to this zone is available up until 30 minutes prior to a schedule class.
• The zone is unavailable for generic training during World Gym WG30 Classes
• No equipment is to be removed from the World Gym WG30 Zone

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Rock-climbing consent*

By checking the box I hereby acknowledge that, at times, the Rock Wall Area at World Gym Bundaberg may be unsupervised and I accept full responsibility for my own actions and any injury I may suffer during these times.

a) No use of the Rock Climbing Wall outside of staffed hours which are ;
Monday - Thursday - 5 am - 9 pm
Friday - 5 am - 6.30 pm
Saturday - 7 am - 4 pm
Sunday - 7 am - 4 pm
b) The Perfect Descent Climbing System is designed for use by one person at a time. The designed
weight range is between 11.5kg and 140kg (25lbs and 310lbs). Persons with muscular, skeletal, or other
physical disorders should consult a physician before using the Perfect Descent Climbing System.
Consult a physician if there is any question about physical ability to safely climb or use this product.
b) I hereby agree that I have completed the Safety Induction at World Gym Bundaberg for the Rock Climbing Wall and been instructed on proper use of the Perfect Descent Climbing System as well as shown the associated consequences of improper use of the Perfect Descent Climbing System and associated equipment.
c) I understand that before entering the Rock Wall enclosure I MUST check in at World Gym Bundaberg reception during the staffed hours noted above to sign in a Wall Climbing Register, ensure that I have completed Safety Training and been properly fit and secured in a certified climbing harness provided by World Gym Bundaberg. A staff member will accompany you to the Rock Wall to ensure that you have properly attached the Perfect Descent Climbing System carabiner to their climbing harness prior to climbing.
d) I hereby agree that I have been Instructed on proper techniques for ascending and descending using the Perfect Descent Climbing System.
e) I hereby agree that I have been Instructed on what to do in the event that a slack line condition, or improper retraction rate is observed
f) I hereby have been explained and are familiar with the site rescue plan in the event that I become distressed during my climb.
g) Ensure the carabiner is properly attached to the climbing harness per manufacturer’s recommendation and
h) the gate is fully closed and locked before starting to climb. Some models may be equipped with dual
i) carabiners, both carabiners must be attached to the same point on the harness before climbing.
j) You MUST see reception before your climb so they can unlock the gate.

FAILURE TO PROPERLY CONNECT CAN RESULT IN SERIOUS INJURY OR DEATH.

j) Prior to climbing, the user must be aware of, and completely understand the following precautions:
o Check the Perfect Descent by pulling out a short section of lanyard and allowing it to retract.
o If the Perfect Descent line fails to retract during climbing, stop climbing immediately and
request assistance.
o Check that the climbing harness is correctly fitted and tightened.
o Check that the carabiner(s) from the Perfect Descent lanyard is connected to the designated
attachment point on the climbing harness and ensure the gate(s) is properly closed.
o Ensure the carabiner latch gate is facing away from the climber. (Single carabiner models)
• If equipped with a dual carabiner connection both carabiners must be connected to the
same attachment point of the harness. The gates of carabiners must face opposite of
each other.
o Never climb alongside or above the Perfect Descent.
o Never start descent from above the Perfect Descent.
o Prior to descent, ensure descent path and landing area are free of people and obstructions.
o Always descend feet first using feet to fend off obstacles and prepare for landing.
o Never pull the lanyard out prior to initiating descent

This World Gym location is a licence of World Gym International, Inc and is independently owned and operated. FITNESS REPRESENTATION: ASSUMPTION OF RISK; RELEASE AND LIABILTY WAIVER; INDEMNIFICATION OF WORLD GYM THIS IS A LEGALLY BINDING WAIVER, RELEASE AND INDEMNIFICATION. PLEASE READ IT CAREFULLY BEFORE SIGNING.*

I agree to the following:

In considering for my use of World Gym facilities, I hereby stipulate and agree as follows:

I realise and accept the risks of cardiovascular exercise, weight lifting, weight training and/or body building, and I am fully aware of the possibility of mechanical and/or other malfunctions of cardiovascular equipment, weight machines, and/or apparatus (“equipment”) due to the negligence of World Gym or otherwise, as well as the possibility of injury to me as a result of my or others’ use of such cardiovascular equipment, weight machines, and/or weight machines and apparatus. I fully understand and accept the serious consequences which might result due to my involvement in cardiovascular exercise and weight training and/or body building while at World Gym premises. Based on that understanding, I voluntarily assume any and all risk of, and hereby fully, unconditionally and forever release World Gym, its franchiser/licensor, and all of World Gym employees, owners, shareholders, directors, agents, independent contractors and affiliates from any loss, damage, injury or claims of any kind whatsoever that relate to my or others’ use of any and all of the equipment and facilities of World Gym.

I represent and warrant that I am in physically sound condition and I have no disability or impairment that would prevent me from engaging in active or passive exercise that would be detrimental to my health, safety or physical condition. I am in good health and have no physical conditions that would be aggravated by my involvement in cardiovascular exercise, weight lifting, weight training and/or body building, nor do I have any physical limitations that would procure such involvement. I have medical approval to proceed with a normal routine of exercise, and all exercises shall be undertaken by me at my sole risk. I understand and agree that World Gym is not responsible
for evaluating my physical condition and will not undertake to do so.

I understand that World Gym will not provide or pay for medical and/or hospitalisation care or insurance for my benefit in the event of any injury to me occurring as a result of my being on any portion of the premises of World Gym.

I will abide by the World Gym Rules and Regulations, as they may be changed or updated from time to time in World Gym’s sole discretion. I will comply with all Rules and Regulations regarding my guests, and I will cause my guests to comply with all Rules and Regulations at any time, World Gym shall have the right, in it’s sole and absolute discretion at any time, to cancel my membership, and in such event I will not be entitled to a refund for any prepaid membership fees that would have been accrued for the rest of the term.

In attending World Gym and using its facilities and equipment, I agree that I am doing so at my own risk. I understand that it is not World Gym’s responsibility to supervise my or others’ use of the equipment or facilities or conduct within or around the premises, and I understand and agree that World Gym shall not be liable or responsible for any personal injuries (including death) or property loss, theft or damage I sustain on or around the premises of World Gym, whether or not World Gym is alleged to be negligent.

I hereby assume all responsibility for any personal injuries (including death), property loss, or property damage that I may suffer, or that I or any of my guests cause others to suffer, in connection with my, or my guest’s, use of the equipment or facilities of World Gym or my presence within or around the premises of World Gym. With Full knowledge of the consequences, i.e., that I am waiving my right to sue, I voluntarily and expressly waive and agree to unconditionally, fully and forever release World Gym and all of its employees, owners, shareholders, directors, agents, independent contractors, affiliates, successors and assigns, and its franchiser/licensor, from all liability or claims for, or relating to, any personal injury (including death), property loss, theft or property damage, tortious acts or omissions, unlawful acts or omissions, or other claims of whatever nature sustained or asserted by me in connection with my, or others’ use of World Gym equipment or facilities or my or others’ presence or conduct on or around the premises of World Gym, and not withstanding the negligence or alleged negligence of World Gym. This release and waiver will survive my termination of membership.

I also assume full responsibility for, and agree to indemnify, defend and hold harmless World Gym and all of its employees, owners, shareholders, directors, agents, independent contractors, affiliates, successors and assigns, and its franchiser/licensor (collectively, “World Gym”), against any claims, damages, liability or expenses (including reasonable legal fees) for, any personal injury (including death), property loss, theft or damage, tortious acts or omissions, or other claims of whatever nature asserted by any other person or entity against World Gym in connection with my, or my guest’, use of the World Gym equipment or facilities or my, or my guests’, presence or conduct on or around the premises of World Gym , and notwithstanding the negligence or alleged negligence of World Gym. This indemnification will survive the termination of my membership.

I acknowledge and intend that this release and waiver of rights shall be affective not only on the date hereof, but also on all occasions subsequent hereto.

I UNDERSTAND THAT THESE PROVISIONS CONTAIN A COMPLETE AND UNCONDITIONAL WAIVER AND DISCLAIMER IN FAVOUR OF WORLD GYM. I understand that by signing below, I am waiving my right to sue World Gym (as defined above) if I suffer any injury, losses or damages of any nature whatsoever. I also understand that, by signing below, I am agreeing to indemnify World Gym and I am taking full responsibility for any claims or damages that may be made against World Gym by any other person as the result of my, or my guests’, acts or omissions within or around the premises of World Gym. This waiver, release and indemnification will survive the termination of my membership.

I acknowledge that, at times, the facility World Gym may be unsupervised and I accept full responsibility my own actions during these times.

WORLD GYM AUSTRALIA PASSPORT MEMBERSHIP
(A) “Passport Membership”: A member can use participating World Gym clubs if they join up as a Passport Member depending the Passport type. When a Passport member joins their contract is with World Gym Australia. A Passport member pays a higher fee than a standard member which is a fixed rate set by World Gym Australia. A Passport member must join up at the club they most frequently use (“Home club”), and may use other participating World Gym clubs (“Away clubs”). World Gym Franchisees sell Passport memberships for World Gym Australia.

(B) Transfers of Passport Memberships between clubs may automatically occur from time to time. After the initial 6 months of a Passport membership, if over a 3-month period a Passport Member’s visits are greater than 60% at an Away club and in-line with the World Gym Australia Passport Membership Policy, from that time that club will be designated as the Member’s Home club. This club will then be considered your HOME club and all other clubs AWAY clubs. Both the clubs and the Member will be notified once this change occurs.

First and Last Name*

ELECTRONIC SIGNATURE - I believe that to the best of my knowledge, all of the information on the Pre-Screening that I have supplied within this tool is correct. I hereby agree to abide by the above rules and regulations and report any undesireable behaviour or breachs to the above.

Signature*

I hereby acknowledge that by signing: • The information provided above my health is to the best of my knowledge correct. • I will inform you immediately if there are any changes to the information provided above.

Total

Credit Card