Change of Membership

First Name:

Surname:

Phone:

Email:

Please select your current membership:

Please select the membership you wish to change to:

Adult Pre-Exercise Screening

Has your Doctor ever told you that you have a heart condition or have you ever suffered a stroke?:

Yes
No

Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?:

Yes
No

If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last three months?:

Yes
No

Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?:

Yes
No

Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?:

Yes
No

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?:

Yes
No

Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?:

Yes
No

By ticking this box I have read and understand I am bound by terms and conditions of the selected membership type. Including but not limited to:

This is an ongoing membership agreement
If you are upgrading from an aquatic membership to an all access active membership, there may be an upgrade fee of $50 ($20 concession) to cover the additional start up fees of an active membership which will be added to your next direct debit
Any pro- rata amount (ie, the amount you pay for the days of your membership that fall before the direct debit) will also be added to the next direct debit.
Lifestyle contracts require a $49 early exit fee to terminate the contract within the 6 month minimum term
28 days’ notice of cancellations is required for all membership types
If changing from a Flexi to a Lifestyle contract, the minimum 6 month term will commence from the date my request is approved
I forfeit my current contract price when changing my membership.

Notes: Are there any other specifics about this change that we need to know?:

Upload proof of concession if required (front):

Upload proof of concession if required (back):

Staff member initial: