Purity Gym - Changing Bodies, Building Confidence

1A King Street, Wellington, Telford, TF3 1AH
01952 252770
info@puritygym.co.uk

Application Form

Home Application Form

Full Name

Date of Birth

Address

Email

Telephone

Occupation

I am

Emergency Contact

Membership Type

Gym & Morning Ladies Classes Anytime Gym Classes Not Included P.T Trial - Includes 4 x 30 minute P.T session and 1 month gym pass Classic Client - Gym and 1 x 30 minute P.T. Per Week Lifestyle - Gym and 1 x 45 minute P.T. Per Week Progressive - Gym and 2 x 30 minute P.T. Per Week Elite - Gym and 2 x 45 minute P.T. Per Week Contract Membership Non-Contract Membership Joint Membership

Part A - Health - Select all that apply to you.

Smoker High Blood Pressure Heart Murmur Exercise Regularly High Cholesterol Angina Family History of Heart Disease Type 2 Diabetes Allergies

Part B - Medical History - Select any you have been diagnosed with or are currently managing/treating.

Hernia Chronic illness Stroke Angina Cancer Digestive problems Depression Anxiety Osteoporosis Other Bone/Joint Condition Back Problems I have had a recent operation I am currently pregnant Osteo - Arthritis Other Muscular Condition Loss of Sleep Emphasema Type 1 Diabetes Rheumatoid Arthritis Multiple Sclerosis

I am aware that any physical activity that I may take part in, may present a heightened risk of injury, ill health or death.

Yes

I declare that I have answered all the questions in this health appraisal to the best of my knowledge and that this is a true reflection of my current state of health. I accept that Purity Gym Ltd may ask for further advice from my GP or other recognised health professional before I can access their services.

Yes

Purity Gym to use my image in promotions.

I understand it is my responsibility to advise the gym immediately, of any change to your medical condition. From this date and to provide a newly completed health questionnaire.

Yes

Contracts

Press the below to view an example 12-month gym contract.

Example Contract

Purity Gym is an independent boutique Gym, established in 2015 and has been bringing a top-notch fitness facility to the people of Telford and its surrounding areas since then.

Copyrights © 2023 Purity Gym. Designed by ETAK Creative