Terms and conditions

Please read the following carefully and sign the declaration below. If you are under 18 a parent or guardian must also sign. If you Gym Membership greenbank
are unable to sign for any other reason, a nominated responsible person may do so on your behalf. sports academy
• You must ‘swipe in’ at reception using your membership card upon arrival. Without your membership card, you will be unable to use the gym.
• If a card is lost, a replacement will be made on receipt of £2 to cover our administrative costs.
Application Form
• Off peak members are restricted to the use of the gym facilities between the hours of 8.30am and 4pm, Monday to Friday, and all day
on Saturday and Sunday.
• Members who opt for a direct debit membership agree to join for a minimum of 6 months. The first month is payable in advance by • Please fill out all necessary details including your method of payment and the direct debit mandate, (if applicable). It is
cash or credit/debit card. This 6 month period is considered paid for after the 5th payment via direct debit. From then on the
important that the medical questionnaire is completed and signed as well as the terms and conditions of the contract.
membership will roll over on a monthly basis. This will continue until the membership is terminated. Direct debits will be taken on the first
• The minimum age for members is 16 unless approved by the Gym Manager.
Friday of each month.
• To cancel a direct debit membership, members must give one month’s written notice. Prepaid memberships are non-refundable. There • Concession rates apply to disabled users.
is a 7 day cooling off period for new gym members who take out the direct debit option. The first month’s payment is non-refundable. • We will need to take a photo of you at reception to put with your membership details.
The 7 days starts form the date of induction.
• The gym is for the use of Greenbank Sports Academy members only, therefore guests are not allowed. IMPORTANT - DATA PROTECTION
• During busy periods please limit your time on popular equipment such as the treadmills. Greenbank Sports Academy collects and processes information about gym members. The Data Protection Act 1998 requires
• For reasons of health and safety, members must adhere strictly to the following: Greenbank Sports Academy to obtain your agreement before this can be done. In signing this form you are giving consent
- All free weights are to be returned to their racks after use. for your personal and sensitive information to be processed under the rules and safeguards laid down by the 1998 Act.
- Cups and mugs are not allowed in the gym or studio.
Greenbank Sports Academy has procedures in place to ensure that all information held about you will be dealt with
- Members should bring a small towel to wipe down machinery after use.
confidentially, held securely and only processed in accordance with Greenbank Sports Academy’s notification to the
- Tracksuits or shorts and t-shirts must be worn at all times.
- Suitable footwear should be worn at all times. Information Commissioner, who administers the Act. Greenbank Sports Academy may wish to contact you for marketing
- Offensive language or behaviour will not be tolerated. purposes. If you do not wish to be contacted in this way, please tick this box
- Clashing weights, excessive noises and mistreatment of equipment will not be tolerated.
• Anyone thought to be under the influence of alcohol or drugs will be ejected and their membership will be reviewed. Thank you for taking time to complete your application carefully and we look forward to welcoming you to our gym.
• If, for any reason, a direct debit payment fails to credit our account, membership will be suspended until payment resumes or another
payment method is used.
• Greenbank Sports Academy management reserve the right to exclude any member they deem not to be adhering to any of the above Personal details
or who by their actions poses a health and safety risk to others.
Surname: Mondragon Garcia
Declaration
First name: Marco Date of birth: September 16, 2008
I confirm that all the answers above are true to the best of my knowledge and I believe I am able to participate in exercise at Address: Colonia san martin azcatepec calle benito juarez numero 22
Greenbank Sports Academy.

Signature: Date: / /
Postcode: 55748
The person making this application is under 18 or unable to sign themselves. Therefore I confirm that I will be taking
responsibility for this person’s declaration. Home number: seven Mobile number: 5549113231

Name: Relationship: Email: marcopaolo888@[Link]

Signature: Date: / / Do you declare a disability? Yes No ✔

If yes, please specify:

How did you hear about us?

Friend / family Website / online search engine

Emergency contact details
Leaflet Driving / walking past

Other (please specify): Contact name: Virginia Home number: seven

Relationship: Mom Mobile number: 5534260836

Greenbank Sports Academy

Greenbank Lane
OFFICE USE ONLY
Liverpool
L17 1AG Induction date: 11/14/2024 Membership type: 12 month package

Membership Number: membership 3 Payment type: monthly

Tel: 0151 280 7757
Website: [Link] Staff name: Paco momazos Staff signature: Paco momazos
Email: [Link]@[Link]
 greenbank greenbank
sports academy sports academy

Membership type Consent to exercise

• Exercising is an essential part of maintaining a healthy lifestyle. Some people however are unable to participate fully due
With our 'Anytime' and 'Off Peak' memberships as well as different payment options, we offer a choice that is either most
to illness or other medically restrictive reasons. It is therefore important that the following questions are answered fully and
cost effective or more convenient for you.
honestly to enable us to ensure that our members can exercise safely.
Anytime membership entitles the member to use the gym at any time during opening hours. • Please ensure that you sign the declaration below.
• If you are under 18 a parent or guardian must also sign.
Off Peak membership entitles the member to use the gym from 8.30am - 4pm Monday to Friday and all day on Saturday • If you are unable to sign for any other reason, a nominated responsible person may do so on your behalf
and Sunday.

All gym members are required to undergo an induction before using the gym. Physical Activity Readiness Questionnaire (PARQ) Yes No
Please indicate the type of membership you require by ticking the relevant box. Have you, for any reason, been unable to exercise in the past?

Has your physician ever advised you against exercising?

3, 6 or 12 month membership
Have you ever suffered from any cardiac (heart) related illness?

Have you ever suffered from respiratory difficulties?

Type Anytime Off Peak
Have you ever suffered from fainting, migraines or loss of balance?

Have you ever suffered from any bone, joint or muscle related disease?
3 months £60 £45
Is there any history of heart disease in your family?
6 months £110 £80
Have you experienced chest pain whilst exercising?
12 months £220 ✔
£165
Do you have high blood pressure?
Disability 3 months £42 £31.50
Do you have elevated cholesterol levels?
Disability 6 months £77 £56
Are you currently taking prescribed medication?
Disability 12 months £154 £112
Student 3 months If you answered ‘yes’ to any of the above, please give details below. All information is held in strictest confidence and
£45
accessible only by the gym manager and relevant staff.
Student 6 months £80
Student 12 months £165 Your doctor’s details
Greenbank Student (monthly) £15
Doctor’s name: Surgery name:

Surgery number: Surgery address:

Direct debit membership
Declaration of consent to exercise
Type Anytime Off Peak
I confirm that all the answers above are true to the best of my knowledge and I believe I am able to participate in exercise at
Greenbank Sports Academy.
Monthly* £20 ✔
£15 Signature: Date: / /
Disability (monthly)* £14 £10.50 The person making this application is under 18 or unable to sign themselves. Therefore I confirm that I will be taking
Student (monthly)* £15 responsibility for this person’s declaration.

Name: Relationship:

Signature: Date: / /
*minimum of 6 months membership
 greenbank greenbank
sports academy sports academy

Membership type Consent to exercise

• Exercising is an essential part of maintaining a healthy lifestyle. Some people however are unable to participate fully due
With our 'Anytime' and 'Off Peak' memberships as well as different payment options, we offer a choice that is either most
to illness or other medically restrictive reasons. It is therefore important that the following questions are answered fully and
cost effective or more convenient for you.
honestly to enable us to ensure that our members can exercise safely.
Anytime membership entitles the member to use the gym at any time during opening hours. • Please ensure that you sign the declaration below.
• If you are under 18 a parent or guardian must also sign.
Off Peak membership entitles the member to use the gym from 8.30am - 4pm Monday to Friday and all day on Saturday • If you are unable to sign for any other reason, a nominated responsible person may do so on your behalf
and Sunday.

All gym members are required to undergo an induction before using the gym. Physical Activity Readiness Questionnaire (PARQ) Yes No
Please indicate the type of membership you require by ticking the relevant box. Have you, for any reason, been unable to exercise in the past? ✔

Has your physician ever advised you against exercising? ✔

3, 6 or 12 month membership
Have you ever suffered from any cardiac (heart) related illness? ✔

Have you ever suffered from respiratory difficulties? ✔

Type Anytime Off Peak

Have you ever suffered from fainting, migraines or loss of balance? ✔

Have you ever suffered from any bone, joint or muscle related disease? ✔

3 months £60 £45

Is there any history of heart disease in your family? ✔

6 months £110 £80

Have you experienced chest pain whilst exercising? ✔

12 months £220 £165

Do you have high blood pressure? ✔

Disability 3 months £42 £31.50

Do you have elevated cholesterol levels? ✔

Disability 6 months £77 £56

Are you currently taking prescribed medication? ✔

Disability 12 months £154 £112

Student 3 months If you answered ‘yes’ to any of the above, please give details below. All information is held in strictest confidence and
£45
accessible only by the gym manager and relevant staff.
Student 6 months £80
Student 12 months £165 Your doctor’s details
Greenbank Student (monthly) £15
Doctor’s name: Surgery name:

Surgery number: Surgery address:

Direct debit membership
Declaration of consent to exercise
Type Anytime Off Peak
I confirm that all the answers above are true to the best of my knowledge and I believe I am able to participate in exercise at
Greenbank Sports Academy.
Monthly* £20 £15 Signature: Date: / /
Disability (monthly)* £14 £10.50 The person making this application is under 18 or unable to sign themselves. Therefore I confirm that I will be taking
Student (monthly)* £15 responsibility for this person’s declaration.

Name: Virginia Relationship: Mom

Signature: Date: 14 / 11 / 2024

*minimum of 6 months membership
Terms and conditions
Please read the following carefully and sign the declaration below. If you are under 18 a parent or guardian must also sign. If you Gym Membership greenbank
are unable to sign for any other reason, a nominated responsible person may do so on your behalf. sports academy
• You must ‘swipe in’ at reception using your membership card upon arrival. Without your membership card, you will be unable to use the gym.
• If a card is lost, a replacement will be made on receipt of £2 to cover our administrative costs.
Application Form
• Off peak members are restricted to the use of the gym facilities between the hours of 8.30am and 4pm, Monday to Friday, and all day
on Saturday and Sunday.
• Members who opt for a direct debit membership agree to join for a minimum of 6 months. The first month is payable in advance by • Please fill out all necessary details including your method of payment and the direct debit mandate, (if applicable). It is
cash or credit/debit card. This 6 month period is considered paid for after the 5th payment via direct debit. From then on the
important that the medical questionnaire is completed and signed as well as the terms and conditions of the contract.
membership will roll over on a monthly basis. This will continue until the membership is terminated. Direct debits will be taken on the first
• The minimum age for members is 16 unless approved by the Gym Manager.
Friday of each month.
• To cancel a direct debit membership, members must give one month’s written notice. Prepaid memberships are non-refundable. There • Concession rates apply to disabled users.
is a 7 day cooling off period for new gym members who take out the direct debit option. The first month’s payment is non-refundable. • We will need to take a photo of you at reception to put with your membership details.
The 7 days starts form the date of induction.
• The gym is for the use of Greenbank Sports Academy members only, therefore guests are not allowed. IMPORTANT - DATA PROTECTION
• During busy periods please limit your time on popular equipment such as the treadmills. Greenbank Sports Academy collects and processes information about gym members. The Data Protection Act 1998 requires
• For reasons of health and safety, members must adhere strictly to the following: Greenbank Sports Academy to obtain your agreement before this can be done. In signing this form you are giving consent
- All free weights are to be returned to their racks after use. for your personal and sensitive information to be processed under the rules and safeguards laid down by the 1998 Act.
- Cups and mugs are not allowed in the gym or studio.
Greenbank Sports Academy has procedures in place to ensure that all information held about you will be dealt with
- Members should bring a small towel to wipe down machinery after use.
confidentially, held securely and only processed in accordance with Greenbank Sports Academy’s notification to the
- Tracksuits or shorts and t-shirts must be worn at all times.
- Suitable footwear should be worn at all times. Information Commissioner, who administers the Act. Greenbank Sports Academy may wish to contact you for marketing
- Offensive language or behaviour will not be tolerated. purposes. If you do not wish to be contacted in this way, please tick this box
- Clashing weights, excessive noises and mistreatment of equipment will not be tolerated.
• Anyone thought to be under the influence of alcohol or drugs will be ejected and their membership will be reviewed. Thank you for taking time to complete your application carefully and we look forward to welcoming you to our gym.
• If, for any reason, a direct debit payment fails to credit our account, membership will be suspended until payment resumes or another
payment method is used.
• Greenbank Sports Academy management reserve the right to exclude any member they deem not to be adhering to any of the above Personal details
or who by their actions poses a health and safety risk to others.
Surname:
Declaration
First name: Date of birth:
I confirm that all the answers above are true to the best of my knowledge and I believe I am able to participate in exercise at Address:
Greenbank Sports Academy.

Signature: Date: / /
Postcode:
The person making this application is under 18 or unable to sign themselves. Therefore I confirm that I will be taking
responsibility for this person’s declaration. Home number: Mobile number:

Name: Virginia Relationship: Mom Email:

Signature: Date: 14 / 11 / 2024 Do you declare a disability? Yes No

If yes, please specify:

How did you hear about us?

Friend / family ✔ Website / online search engine

Emergency contact details
Leaflet Driving / walking past

Other (please specify): Contact name: Home number:

Relationship: Mobile number:

Greenbank Sports Academy

Greenbank Lane
OFFICE USE ONLY
Liverpool
L17 1AG Induction date: Membership type:

Membership Number: Payment type:

Tel: 0151 280 7757
Website: [Link] Staff name: Staff signature:
Email: [Link]@[Link]