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Membership
Details
Additional users
Health
Payment
You have selected a
Monthly Family Membership
at a cost of £120.00 per month at the Ivybridge Leisure Centre (Devon) site.
Your details
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Title
Miss
Mr
Ms
Mrs
Dr
First name
Surname
D.O.B
How did you hear about us?
--please select--
Outreach/Awareness
Website
Corporate
Signage
Guest/Par Q/Casual
POS Referral
Rejoin
Referral
Swim School
Post code
FIND ADDRESS
EDIT ADDRESS
Address
Address 2
Town
County
Telephone
Mobile
Preferences
I will accept communication via:
Email
Post
SMS
Social Media
Telephone
I wish to hear about the following items:
Centre Updates
Membership Information
Special Offers
Surveys
Please confirm by entering into the contract with us you agree to receiving communication regarding your accounts, subscriptions, and participating activities. You may receive service messages. Your data may be shared with third parties for agreed data processing such as the collection of subscription fees. Please refer to our privacy policy for more details. To read the privacy policy click
here
:
Step 2.
Your details
Name:
Pal Kienitz
Edit
Email:
pal.kienitz@dcslsoftware.com
Mobile:
12345678
ADULT#2 DETAILS
Title
Miss
Mr
Ms
Mrs
Dr
First name
Surname
D.O.B
How did you hear about us?
--please select--
Outreach/Awareness
Website
Corporate
Signage
Guest/Par Q/Casual
POS Referral
Rejoin
Referral
Swim School
Post code
Address
Address 2
Town
County
Telephone
Mobile
I will accept communication via:
Email
Post
SMS
Social Media
Telephone
I wish to hear about the following items:
Centre Updates
Membership Information
Special Offers
Surveys
Please confirm by entering into the contract with us you agree to receiving communication regarding your accounts, subscriptions, and participating activities. You may receive service messages. Your data may be shared with third parties for agreed data processing such as the collection of subscription fees. Please refer to our privacy policy for more details. To read the privacy policy click
here
:
CHILD#1 DETAILS
Title
Miss
Mr
Ms
Mrs
Dr
First name
Surname
D.O.B
How did you hear about us?
--please select--
Outreach/Awareness
Website
Corporate
Signage
Guest/Par Q/Casual
POS Referral
Rejoin
Referral
Swim School
Post code
Address
Address 2
Town
County
Telephone
Mobile
I will accept communication via:
Email
Post
SMS
Social Media
Telephone
I wish to hear about the following items:
Centre Updates
Membership Information
Special Offers
Surveys
Please confirm by entering into the contract with us you agree to receiving communication regarding your accounts, subscriptions, and participating activities. You may receive service messages. Your data may be shared with third parties for agreed data processing such as the collection of subscription fees. Please refer to our privacy policy for more details. To read the privacy policy click
here
:
CHILD#2 DETAILS
Title
Miss
Mr
Ms
Mrs
Dr
First name
Surname
D.O.B
How did you hear about us?
--please select--
Outreach/Awareness
Website
Corporate
Signage
Guest/Par Q/Casual
POS Referral
Rejoin
Referral
Swim School
Post code
Address
Address 2
Town
County
Telephone
Mobile
I will accept communication via:
Email
Post
SMS
Social Media
Telephone
I wish to hear about the following items:
Centre Updates
Membership Information
Special Offers
Surveys
Please confirm by entering into the contract with us you agree to receiving communication regarding your accounts, subscriptions, and participating activities. You may receive service messages. Your data may be shared with third parties for agreed data processing such as the collection of subscription fees. Please refer to our privacy policy for more details. To read the privacy policy click
here
:
Your health
Set all to "Yes"
Set all to "No"
Has your doctor ever said you have any heart condition and that you should only do exercise/physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do exercise/physical activity?
Yes
No
In the past month have you had chest pains when you were not doing exercise/physical activity?
Yes
No
Do you lose balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint/back problem which could be made worse by a change in your exercise/physical activity?
Yes
No
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
Any other significant illness, recent or serious operation?
Yes
No
Do you know of any other reason why you should not exercise or do physical activity?
Yes
No
"Yes" was selected for one of the options. By proceeding you confirm you have consulted with your doctor and are safe to join the gym
I confirm
I do not confirm
ADULT#2 HEALTH
Set all to "Yes"
Set all to "No"
Has your doctor ever said you have any heart condition and that you should only do exercise/physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do exercise/physical activity?
Yes
No
In the past month have you had chest pains when you were not doing exercise/physical activity?
Yes
No
Do you lose balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint/back problem which could be made worse by a change in your exercise/physical activity?
Yes
No
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
Any other significant illness, recent or serious operation?
Yes
No
Do you know of any other reason why you should not exercise or do physical activity?
Yes
No
"Yes" was selected for one of the options. By proceeding you confirm you have consulted with your doctor and are safe to join the gym
I confirm
I do not confirm
CHILD#1 HEALTH
Set all to "Yes"
Set all to "No"
Has your doctor ever said you have any heart condition and that you should only do exercise/physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do exercise/physical activity?
Yes
No
In the past month have you had chest pains when you were not doing exercise/physical activity?
Yes
No
Do you lose balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint/back problem which could be made worse by a change in your exercise/physical activity?
Yes
No
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
Any other significant illness, recent or serious operation?
Yes
No
Do you know of any other reason why you should not exercise or do physical activity?
Yes
No
"Yes" was selected for one of the options. By proceeding you confirm you have consulted with your doctor and are safe to join the gym
I confirm
I do not confirm
CHILD#2 HEALTH
Set all to "Yes"
Set all to "No"
Has your doctor ever said you have any heart condition and that you should only do exercise/physical activity recommended by a doctor?
Yes
No
Do you feel pain in your chest when you do exercise/physical activity?
Yes
No
In the past month have you had chest pains when you were not doing exercise/physical activity?
Yes
No
Do you lose balance because of dizziness or do you ever lose consciousness?
Yes
No
Do you have a bone or joint/back problem which could be made worse by a change in your exercise/physical activity?
Yes
No
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Yes
No
Any other significant illness, recent or serious operation?
Yes
No
Do you know of any other reason why you should not exercise or do physical activity?
Yes
No
"Yes" was selected for one of the options. By proceeding you confirm you have consulted with your doctor and are safe to join the gym
I confirm
I do not confirm
change your details
select payment details
Step 3.
Your health
See my
member healt declaration
Edit
Payment
When do you want your membership to start?