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* 1. Health Commitment Statement

Your Health is your Responsibility. Exercise carries its own risk, and you should therefore never exercise beyond your ability. If you have any doubts as to your fitness, or you have any medical conditions that may affect your safety through exercise, you should seek advice from your doctor before partaking in the activity.'

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* 2. I wish to embark on a programme of physical activity and confirm that I do not have any health conditions which may prevent or adversely affect my participation in an exercise programme and/or induction.

If my health status changes, I will seek guidance and clearance to exercise from my General Practitioner or other relevant heath professional before participating any further in the physical activity.

I acknowledge that I have given my consent to the South Shropshire Leisure Centre to add my details to their database system in order for me to be able to use the facility. I understand that my details will be kept on the system for a minimum of 6 months after my last visit.

I understand that by signing this document I declare myself fit and healthy to use the Cardio Vascular and Fixed Resistance Machines, and that I will do so in a safe and sensible manner.

If I wish to use the Free Weight equipment, I must consult one of the Personal Trainers and receive professional instruction (charge payable to the Personal Trainer) before partaking in the activity.

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* 3. Which Teme centre do you use?

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* 4. Your Teme Leisure Card Number

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* 5. Please complete your personal details below

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* 6. Please complete your DOB below

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* 7. Please complete your personal details below

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* 8. Please complete your personal details below

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* 9. By completing this form you agree to the following:

·  Follow all signage, staff guidance & procedures

· Ensure equipment used is cleaned down before & after use 

· Observe the fitness facility etiquette and demonstrate courtesy towards others in the facility at all times, including allowing adequate social distancing to other users and staff 

· Wear proper training attire at all times including training shoes. NO jeans or workday clothes 

· Your access to the centre can be terminated at any time if you are found to misuse any equipment or facilities.

· Report and injuries to staff on-site

· Tobacco, food, glass bottles, and cans are not allowed within workout areas. Plastic Water Bottles are acceptable

· Respond to any alarms/evacuation procedures & respond to staff accordingly 

·  You understand you are working out at your own risk

·  You agree not to attend the centre if you have any of the Covid-19 symptoms.

·  You give permission for us to contact you via government track and trace in the event of a confirmed Covid-19 case on site

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* 10. Please tick below if you would like to be added to the following mailing lists

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* 11. Have you Downloaded the Teme Leisure FREE App

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* 12. Have you registered or been informed about our Leisure Hub Site

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* 13. I hereby disclaim South Shropshire Leisure Ltd (Teme Leisure) of any injury/fatality which may occur through misuse of the equipment, except where the injury may have been due to negligence by South Shropshire Leisure Ltd (Teme Leisure)

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* 14. Teme Staff Member to initial and date when processed

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