Registration Form
We put huge importance on your well being during our group workouts. Please take a moment to complete our brief pre-exercise health questionnaire before attending your chosen exercise class so we can ensure that your visit with us is as comfortable for you as possible.

Registration with us is the first step to getting you going. Then you have the freedom to choose from our growing range of weekly exercise classes to help you kick start your fitness and start your own personal health and fitness journey.


Email address *
Full Name *
Your answer
Address *
Your answer
Contact Telephone Number *
Your answer
1. Has your doctor ever indicated that you have a heart condition? *
1a. If you have answered yes, please give details below
Your answer
2. Have you ever had chest pains bought on by physical activity? *
2a. If you have answered yes, please give details below
Your answer
3. Has your doctor ever said that your blood pressure was too high? *
3a. If you have answered yes, please give details below
Your answer
4. Do you have a bone, back or muscular problem that may be aggravated by exercise? *
4a. If you have answered yes, please give details below
Your answer
5. Do you suffer from epilepsy? *
5a. If you have answered yes, please give details below
Your answer
6. Do you suffer from asthma? *
6a. If you have answered yes, please give details below
Your answer
7. If you do suffer from asthma, do you carry your pump? *
7a. If you have answered yes, please give details below
Your answer
8. Are you diabetic? *
8a. If you have answered yes, please give details below
Your answer
9. Are you pregnant or have you given birth in the last three months? *
9a. If you have answered yes, please give details below
Your answer
10. Are you taking any medication? *
10a. If you have answered yes, please give details below
Your answer
11. Is there any reason not mentioned above why exercise may not be suitable for you? *
11a. If you have answered yes, please give details below
Your answer
Which of our classes are you interested in? *
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Which of our payment options are you interested in? *
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If you have a code for one of our special promotions, please enter it here
Your answer
Terms & Conditions
Medical Considerations:
• Prior to your first visit to a Blackheath Group Exercise (BGE) class, you are required to complete a health questionnaire, which will be retained safely and securely by BGE.
o It is your responsibility to be honest with your medical information and, if you have any specific medical conditions, to make BGE aware.
o Once completed, it your responsibility to tell BGE of any new ailment, injury or disease that may affect your ability to exercise.
o Whilst BGE takes its responsibility towards delivering a safe and effective class, the final medical responsibility as to whether it is safe for you to exercise rests with you, your GP, physician, clinician or specialist.
• BGE reserves the right to halt your sessions if your medical condition changes:
o A doctor’s letter or certificate will be needed to prove it is safe for you to return to exercise.

General Considerations:
• Classes start and finish at the times published. If you are more than 5 minutes late, the instructor reserves the right to not let you attend:
o It is important that, before the class commences, the instructor can ‘screen’ the class and gain relevant important medical information. By being late, you will affect the instructor’s ability to deliver a safe and effective class and disturb the others in the class.
• BGE will maintain a website, Facebook account and Twitter account so that it can communicate with its members and attendees.
o BGE asks that everyone who uses BGE services to sign up to either the website, facebook or twitter accounts so that we can contact you in the event of an emergency.
o We value your custom and would like to make sure we can keep you updated, especially in the case of an emergency (e.g. unexpected sickness of an instructor, inability to access one of our venues etc.).
• o In the event of ill health, please refer to the medical considerations above.
o You may cancel your monthly standing order at any time. Please talk to Paul Folan to discuss your membership termination date.
o Refunds of your standing order will only be considered in the event of a medical condition and proof of that condition will be required from the diagnosing physician, clinician or specialist.
o In the event of ill health, please refer to the medical considerations above.
o Payment can be made by cash or bank transfer (we regret that we are unable to accept cheques, credit or debit cards as payment).
o Refunds of your payment will only be considered in the event of a medical condition and proof of that condition will be required from the diagnosing physician/clinician.
• ‘Pay As You Go’ refers to those who prefer to pay on a class by class basis. BGE still requires the completion of a health questionnaire for everyone who attends their classes (either via the website or by completing a paper based form).
• ‘5 Classes of the price of 4’ discounts apply to both Premium and Standard classes.
o You can-not transfer your discount to other classes or transfer your discount to any other person. It must be used by the person who purchased it and can-not be given to any other person (even a family member).
• BGE reserves the right to offer future promotions and incentive separate from those incentives or membership already mentioned.
• In the event of an instructor not being available to teach, BGE will endeavour to find a replacement, suitably qualified and insured instructor to deliver the class. There may be times when a slightly different class may need to be delivered than that quoted on our timetable.
o BGE also reserves the right to cancel classes if the event of public holidays or of the venue it hires is not available.
• BGE takes your right to privacy seriously.
o BGE will not pass your medical information on to a 3rd party unless there is a medical emergency and the information you provided us is vital to your treatment.
o BGE will not pass on/sell your personal information onto any other company outside of the BGE and Adappt Group.

Disclaimer
In signing this form I affirm that I answered the questions with accuracy. In the event that I have been advised to seek medical clearance before my commencement of exercise, I agree to contact my GP and take responsibility for obtaining written permission prior to the commencement of any group exercise classes.

I understand that I am responsible for monitoring my own health and should any unusual symptoms occur, I will cease participation and inform my doctor of those symptoms. I understand I must notify Blackheath Group Exercise with any changes to my health.
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