1
MEMBERSHIP FORM
Please complete this form to its entirety. No individual will be allowed to participate in any fitness session without this form
completed and signed. The information on this form is considered confidential and will be held in strictest confidence and
accessible only by the gym manager and relevant staff. Filled forms can be emailed back to [email protected] or delivered to
our gym facility during opening hours.
Applicant Information
Full Name:
DOB:
Last
First
M.I.
Address:
Street Address PO Box
District
Island
Phone:
Email
Emergency Contact: Emergency Contact Phone:
Family Physician: Physician Phone:
Physician Address:
MEMBERSHIP FEES: $50.00 KYD Due every 1
st
of the month before participation in any fitness sessions.
SELECT A FITNESS CLASS TIME
Please stick to the classes and times that you have selected below. Advanced notice is required to swap classes for
proper accommodation.
Mon – Friday
☐ Adult Fitness 6:00 a.m. ☐ Adult Fitness 12:00 p.m. ☐ Afterschool 3:30 p.m. ☐ Adult Fitness 5:30 p.m.
☐ Kickboxing Mon 7:30 p.m. ☐ Senior Team Boxing 6:30 p.m. ☐ Kickboxing Wed 7:30 p.m.
SATURDAYS
☐ Adult Fitness 8:00 a.m. ☐ Junior Team Boxing 9:30 a.m. ☐ Kickboxing 11:00am
Nutrition Consultation/Meal Plan $75 (One off Charge) ☐