Back External Service Sign InDate DD slash MM slash YYYY I am a:*ContractorSupport WorkerHealth ServiceOtherPlease Specify:*Your Name* First Last Organization*Client Name* First Last Phone*Consent* I agreeI, agree that while I am at the Centre/Club or included in any activity external to the premises which is organised, approved or endorsed by the Centre/Club, both my property and person shall be at my own risk and I will not hold the Centre/Club or its owners and operators liable for any personal injury or loss of property which may arise unless due to the negligence of the Centre/Club or its owners and operators or their employees. I warrant that I am physically fit and mentally sound and able to engage in exercise and fitness programs at the centre. I will inform instructors of any condition that may have an affect on my ability to participate in any exercise or fitness program prior to commencement. I agree that the Centre/Club or its owners and operators may use my personal information for internal marketing purposes. The Centre/Club or its owners and operators may use my personal information to develop marketing lists and other programs and may include my name and contact details on marketing lists that offer me goods & services by mail, telephone, facsimile or SMS. Electronic Signature - Please enter your name*Signature*World Gym Burpengary - 3053 3170 - 159-161 Station Road, Burpengary - reception@worldgymburpengary.com.au