Windermere Gym Application Form

This form is step 1 of two steps in the join-up process. Once you've completed the form we'll see you at the Centre to get your membership card and start your workouts! 

Privacy: The personal information collected will be held confidentially; it will only be used in relation to your gym membership and will not be shared with any third party without your express consent, pursuant to the requirements of the Privacy Act 1993.
 
Gender
Emergency Details
Medical Details
Does/has anyone in your family under 60 suffer(ed) heart disease, stroke, raised cholesterol or sudden death?
Do you have a heart condition?
Are you a male over 35, or female over 45, and not used to regular exercise?
Have you been hospitalised recently?
Are you pregnant?
Do you have a heart murmur?
Do you have high blood pressure (greater than 149/90)
Do you/have you experience(d) palpitations or pain in the chest?
Do you have raised cholesterol/triglycerides?
Do you have/have you had gout, stroke, diabetes, epilepsy, hernia, or glandular fever?
Do you have/have you had rheumatic fever, dizziness, or fainting?
Do you have/have you had a liver or kidney condition?
Do you have/have you had a stomach or duodenal ulcer?
Do you have/have you had arthritis, asthma, cramps, muscular pain?
Do you smoke?
Are you dieting or fasting?
Health and Fitness Background
How would you describe your current physical condition?

Contact information

Gym (Aquatic and Fitness Centre), Windermere Campus

07 557 8648

Monday-Friday, 5:15am-8:00pm

Saturday and Sunday, 7:00am-2:00pm

Weekend members' family swim from 12 noon-2:00pm

Refer to the webpage for specific hours over holiday periods