07 4688 0700
theworks@studentguild.com.au
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Casual Visit for – Springfield / Ipswich
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Casual Visit for – Springfield / Ipswich
Name
*
First
Last
USQ Student/Staff Card Number (if applicable):
Card Expiry (if applicable):
MM slash DD slash YYYY
Contact Number
*
Date of Birth
*
MM slash DD slash YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email Address
*
Location
*
Springfield
Ipswich
How did you hear about us
*
Social Media
Search Engine
CBRC Event
Member Referral
Emergency Contact
Emergency Contact Name
*
First
Last
Emergency Contact Relationship
*
Emergency Contact Number
*
Adult Pre-Exercise Screening
If you answer YES to any of the below, you may be required to provide a medical certificate from your general practitioner before undertaking any activities.
1. Has your medical practitioner ever told you that you have a heart condition, or have you ever suffered a stroke?
*
Yes
No
2. Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity?
*
Yes
No
3. Do you ever feel faint, dizzy, or lose balance during physical activity/exercise?
*
Yes
No
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
*
Yes
No
5. If you have diabetes (Type 1 or 2), have you had trouble controlling your blood sugar (glucose) level in the last 3 months?
*
Yes
No
6. Do you have any other known conditions that may require special consideration for you to exercise?
*
Yes
No
Casual Visit Terms
1. All patrons visiting The Works Gym He3alth and Recreation Clubs are required to adhere to the Terms and Conditions upon entry. This is displayed in the reception foyer. ( Please see: https://usqworks.com.au/conditions-of-entry/) 2. All patrons must follow the Workplace Health & Safety requirements and all current government regulations. 3. All patrons are required to show courtesy and display respectful behaviour to all other guests in the centre including employees. 4. Personal belongings brought to the premises are at your own risk. The USQ Student Guild is not liable for any losses or damages. 5. You must be over 16 years of age to enter the gym and upon entering, do so at your own risk. Children under 16 years of age are permitted to use the gym when supervised by an adult. You are not permitted to use the gym under 13 years of age 6. If you are entering the gym, it is a requirement to clean and sanitise all equipment used and place it back when it belongs. 7. All patrons who are attending the gym, fitness classes, social sports, or any other physical activity must wear closed in shoes for safety
I have read the Casual Visit Terms in full and agree to be bound to the terms described above.
*
I agree to the Casual Terms.
