Online Form - COPY - Multi Entry Pass Registration

Leisurelife	Gym
Monday - Thursday	5:30am - 8:30pm
Friday	5:30am - 8pm
Saturday	8am - 6pm
Sunday	8am - 4pm

Aqualife	Gym	Pool
Monday - Friday	5:30am - 8:30pm	5:30am - 8:30pm
Saturday and Sunday	7am - 5pm	7am - 5pm

First Name *

Last Name *

Phone *

Email *

Address *

Suburb *

Postcode *

Date of Birth *

Emergency Contact Name *

Emergency Contact Number *

Please select required pass *

Start Date *

Disclaimer:
1. The Town of Victoria Park will do all it reasonably can to provide you with a safe, rewarding and positive experience at our Town of Victoria Park Health Clubs. Completion of this form will be taken as your acceptance of our terms and conditions as specified. We will do all we reasonably can to ensure that our commitments in this regard are met and satisfied. Likewise, we have a reasonable expectation that the commitments made by you by completion of this form will also be met, in full.
2. The Town of Victoria Park accepts that in the unlikely situation where I, and if being a minor, or under legal disability, my parents, guardian/s, suffers an injury, loss and/or damage and investigations indicate this has arisen due to the Town of Victoria Parks negligence, the affected party has the right under the Common Law to instigate legal action to recover any such losses, costs etc that may have arisen. The Town has effected Public Liability insurance to meet the costs that may arise under such circumstances. However, participants should be aware that should they suffer injury loss and/or damage for reasons other than the Towns negligence, then any losses, costs of whatever nature will not be met by the Council.
3. I warrant that I am physically fit and able to engage in exercise and fitness programs.
4. You must comply with the rules outlined on signage and marketing collateral by the Town of Victoria Park Health Club. Towels in the gym, appropriate attire, and consideration must be shown to staff and fellow members at all times. *

I have read the disclaimer associate with the Multi Pass Entry Form and understand and agree to it. I am also aware that these passes are only valid for 12 months from date of issue.