8 Week Challenge - Gym Services

8 WEEK CHALLENGE REGISTRATION

Date*

First and Last Name*

Date of Birth*

Gender*

Male
Female

Mobile*

Email*

Do you have a Personal Trainer that you will be working with during the 8 Week Challenge?*

Yes
No - But I'm interested in finding one. Please contact me to discuss
No - I will be doing the challenge on my own

Note: To qualify for the prize pools you must work with a personal trainer.

Which challenge prize are you looking to win in?*

Weightloss
Muscle Mass Gained

Would you like to enter on a national level?*

Yes
No

Would you like to enter the Mzone competition?*

Yes
No

Name of your PT

PHOTO WAIVER

Consent

I agree to the following Photo Waiver policy:

Full Legal Names: Burpengary Gym Pty Ltd – ABN – 18 614 531 467
Address: Shop 9 , 161 Station Road, Burpengary, QLD, 4505.

Full Legal Names: Raw Power Meals Pty Ltd – ABN – 85 638 498 129
Address: Shop 9 , 161 Station Road, Burpengary, QLD, 4505.

Telephone Number and Email Address: 07) 3053 3170 justin@worldgymburpengary.com.au
(Hereinafter referred to as "the Client")

Whereas for valuable consideration hereby acknowledged as received, the Model granted the Client permission to photograph and/or film and sound record the Model and furthermore grants permission to use the resulting work ("the Work") according to the terms stated hereunder:

• Any permission granted to the Client shall extend to his/her successors, legal representatives, licensees and assigns and shall be irrevocable and perpetual without any further or additional claim for compensation by the Model.
• Use of the Work shall be unrestricted as to location, quantity or frequency, may be for any purpose and in any medium whatsoever, whether foreseen or unforeseen at this time, except where such use is in contravention of the law.
• Permission is specifically granted for the Work to be edited, altered, distorted, used in whole or in part, in conjunction with other images, graphics, text and sound in any way whatsoever and without restrictions.
• Permission herein granted is absolute and final and shall not be subject to further inspection or approval by the Model at any stage in the use of the Work.
• Use of the Work may be in conjunction with the Model's own or fictitious names.
• The Client shall own all rights in the Work which shall accrue to the benefit of his/her successors, legal representatives and assigns.
• Notwithstanding the above, the following uses are specifically noted and agreed to and specific exclusions for use listed here shall take precedence and restrict the use of the Work accordingly:
• The model may use the material produced as provided to them by the client within their own portfolio for personal promotion only. Such license may be withdrawn by the client at any time should it deem the models use of the material as offensive or objectionable
• The Model warrants having read and understood this Model Release Agreement and warrants being of full legal age to enter into an agreement.
• With full knowledge of the above, the Model hereby releases and shall hold harmless the Client and his/her successors, legal representatives, licensees and assigns from all claims or damages including but not limited to defamation or violation of right of privacy or publicity, resulting from or associated with the use of the Work.
• The Model agrees that the provisions contained herein shall be binding upon the Model and his/her successors, legal representatives and assigns.
• This Agreement shall be construed, interpreted and governed in accordance with the laws of the State of Queensland Australia and should any provision of this Agreement be judged by an appropriate court as invalid, it shall not affect any of the remaining provisions whatsoever.
• The parties agree that any or all parts of this agreement may be submitted to the other party in legible and recordable electronic form and upon acknowledgement of receipt by the receiving party shall become valid parts of the agreement.

This agreement has been created in order to develop a mutually beneficial partnership between the client and the model. This agreement can be cancelled with 30 days notice by either party made in writing and submitted to the clients/models nominated email address.

Social Media
You hereby consent World Gym Burpengary "8 Week Challenge" using any film or photographic images of you taken during a training session for promotional and/or advertising purposes.

Signature

PRE-SCREENING

This screening tool does not provide advice on a particular matter, nor does it substitute 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
No

If YES - Please explain*

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

Yes
No

If YES - Please explain*

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

Yes
No

If YES - Please explain*

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

Yes
No

If YES - Please explain*

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

Yes
No

If YES - Please explain*

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
No

If YES - Please explain*

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

Yes
No

If YES - Please explain*

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.

Consent*

I agree to the following regarding the 8 Week Challenge:

Challenge winners will be determined by World Gym Burpengary in accordance with the challenge prize criteria where applicable. One entry is permitted per person. You must be 16 years old or over to enter. To be eligible for a prize, the challenge fees as advised by us must be fully paid at time of registration. The decision of World Gym Burpengary is final and cannot be disputed. If you win a prize, you will be notified immediately by us. If you cannot be contacted within 7 days, you may forfeit your prize. Prizes are not redeemable for cash or other monetary value unless it's a cash prize.

How is the winner judged and what are the prizes?

There will be (3) Categories for Contestants-
a) Muscle Mass Gained. The kg’s of muscle mass gained for 8 weeks.
1st Place Male – Receives $500 Cash – Winning PT - $250 Cash
1st Place Female – Receives $500 Cash - Winning PT - $250 Cash

b) Weight Loss. KGs of Body Fat Lost for 8 weeks.
1st Place Male – Receives $500 Cash - Winning PT - $250 Cash
1st Place Female – Receives $500 Cash - Winning PT - $250 Cash

c) Myzone. Total MEP points earn from your Myzone for 8 weeks
1st Place Male Under 30 Years – Receives $100 Cash
1st Place Male 30 – 40 Years – Receives $100 Cash
1st Place Male 40 – 50 Years – Receives $100 Cash
1st Place Male 50 – 60 Years – Receives $100 Cash
1st Place Male 60+ Years – Receives $100 Cash

1st Place Female Under 30 Years – Receives $100 Cash
1st Place Female 30 – 40 Years – Receives $100 Cash
1st Place Female 40 – 50 Years – Receives $100 Cash
1st Place Female 50 – 60 Years – Receives $100 Cash
1st Place Male 60+ Years – Receives $100 Cash

What do I need to do to ensure my client is eligible for the prizes?
Have your clients before body scans submitted to reception between Monday 3rd– 9th October 2022.
Have your clients after body scans submitted to reception between Monday 5th– 9th December 2022.

Contestants are required to train with one of our PT’s once a week for the 8 Weeks. Excluding Myzone ONLY competitors. PTs are responsible for doing the before and after body scans of their clients. Please ensure the members name is written on top of body scan and that the standard or athletic button has been used for the 2 scans. i.e., both scans must use the same button otherwise the entry will be invalid.

Challenge participants must not use any illegal or banned substances during the challenge. If you are unsure if the challenge is right for you, you should seek advice from a registered medical practitioner.

To be an eligible the 8 Week Challenge prize you must submit your 8-week Challenge Card and your before and after body scans taken by your World Gym Burpengary Personal Trainer. If you provide us with before and after photos, these photos will not be used in social media or otherwise without your consent. You must meet the minimum attendance requirement throughout the challenge period of 16 x Group Fitness Classes/World Gym Athletes classes plus 8 x 30-minute personal training sessions with a World Gym Burpengary Personal Trainer.

World Gym Burpengary reserve the right to change the start and end dates.

First and Last Name*

I understand by SIGNING my name and pressing submit, that the information is true and correct. I will inform you immediately if there are any changes to the information provided above.

Signature