Membership Form
Fill in a membership form for each participant.

There's 4 sections to this form:
1. Participant Details, Payment Options, Referrals & Parkour Gym Survey
2. Parent/Guardian or Emergency Contact #1
3. Parent/Guardian or Emergency Contact #2
4. Conditions
Email address *
Participants Details
Enter the details for the participating person.
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Email *
We'll use this email as the primary contact for the participant. To be as paperless as possible, we send our invoices, booking confirmation and other relevant imformation by email and text. This will NOT opt you into our email newsletter.
Your answer
Subscribe to email newsletter? *
Mobile Phone *
Primary contact for the participant
Your answer
Street Address *
Your answer
Suburb *
Your answer
Post Code *
Your answer
Experience *
Gym Example 1
Gym Example 2
Parkour Gym Location *
We're getting close to leasing a warehouse for a purpose built Parkour & Freerunning Gym. When this happens, members will be able to train during open sessions and classes. Please indicate where you're willing to travel to for such a facility. This facility would accelerate members understanding of techniques in a safe manner and provide the community with a central place to focus on strength and fitness for Parkour & Freerunning. When its up and running, several class options will be available, such as basics classes and more serious progression classes. Members would have access to the facility for blocks of time up to 3 hours during open sessions at a low or nil cost. Check the gym examples above: How far would you travel to regularly visit a purpose built Parkour & Freerunning Gym? Google 'Parkour Gym' for more examples. You can pick more than one location. - Note warehouse space is more expensive and hard to find outside of these locations. It's our hope to secure a facility by early-mid 2019.
Required
Parkour Gym Usage *
When the gym is ready, how many days per week would you train at the gym location's you picked above [note, it's not ready yet]?
Booking Type *
Trial = Casual payment to see if you like it. Term = 10 sessions, once a week during the ACT school term.
Payment Type *
Class Times? *
Select from one of our current session times. Waiting lists apply for each individual session time when full.
Required
Media *
Do you give permission for Run Leap Roll to use images/video and other promotional material of the participant on our website and social media?
Medical
Does the participant have any medical conditions, asthma or allergies, existing or long term injuries that we should be aware of that may limit their ability to participate in our services? If yes, please provide details and supply us with an 'Asthma Action Plan' if needed.
Your answer
Behaviour
Does the participant have any behavioural conditions that we should be aware of? If yes, please provide details.
Your answer
Custody
Are there any custodial matters that we should be aware of in relation to the participant? If yes, please provide details.
Your answer
Notes
Please provide any relevant notes.
Your answer
How did you hear about us? *
Referral
Word-of-mouth is important. We like to recognise those people who spread the word about our services. Which member sent you?
Your answer
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