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DISCLAIMER AND SIGNATURE
1. Empire Health and Fitness, its staff and agents, shall not held liable or held responsible
for any mishap, personal injury or death, loss of property or any loss / damage arising
from or regarding use of the gym equipment.
2. Gym members must sign in and out of the gym at all times.
3. Gym members should maintain a certain level of fitness to use the gym, and to visit a
registered medical doctor if feeling unwell. Please report all injuries to gym staff.
4. Membership is not transferable, non-refundable and last one calendar month. No free
guest passes for friends/ family, all additional attendees must pay £5:00 per session.
5. No children under 16 unless part of a family membership. Strictly no under 13 will be
admitted.
6. Children between the age of 13 and 16 must be accompanied by a responsible adult.
7. Members to be aware that there may be short times that trainers are not available/
present within the gym area/building and the gym may be unattended. Members are
responsible for their own safety during these periods and members should not work out if
they feel that this causes them additional risk.
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PRE-EXERCISE HEALTH QUESTIONAIRE
HOW WOULD YOU DESCRIBE YOUR CURRENT PHYSICAL CONDITION?
UnwellOverweightUnfitHealthyFit
WHAT REGULAR EXERCISE DO YOU CURRENTLY TAKE PART IN?

HAVE YOU EVER HAD OR DO YOU HAVE?
NONESTROKEHEART CONDITIONDIABETESEPILEPSYHEART MURMURDIZZINESSFAINTINGPALPITATIONS OR PAIN IN THE CHESTHIGH BLOOD PRESSURELOW BLOOD PRESSUREMENTAL HEALTH ISSUES
ARE YOU, OR HAVE YOU RECENTLY HAD OR DONE ANY OF THE FOLLOWING?
NONEPRESCRIBED MEDICATION(IF YES WHAT FOR?)ARE YOU PREGNANT? (IF SO, WHEN DUE)GIVEN BIRTH RECENTLY (DATE)DIETING OR FASTINGBEEN IN HOSPITAL RECENTLY
Additional Details

I agree to all above terms in full
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