Runyaway Fitness | Gym, Personal Training, Weight Loss, Health, Aerobics, Sydney

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Runyaway Fitness
1-5 Breust Place
Punchbowl NSW 2196 Australia

Trading Hours
Mon-Fri 5am-10pm
Sat 7am-7pm
Sunday 8am-4pm

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Phone: (02) 9750 9495
Email: enquiry@runyaway.com.au
Website: www.runyawayfitness.com.au

Fill out our Membership Application Form below or DOWNLOAD a copy to print

Membership Information

Full Name

DOB

Occupation

Gender

Phone

Mobile

Work

Address

Suburb

State

Postcode

Email Address

Emergency Contact

Full Name

Address

Phone

Mobile

Work

Health History

Do You Suffer?

Heart Condition	Arthritis	Asthma
Diabetes Type 1	Diabetes Type 2	Blood Pressure
Eplilepsy	Family History of Heart Disease of Stroke

Miscellaneous

Pregnant	Male > 35 years and unaccustomed to excercise
Current/Previous Smoker	Female > 35 years and unaccustomed to excercise
Allergies (Please List)

What have you experienced?

Pain or Tightness in Chest	Heart Palpations	Any many Injuries
Liver/Kidney Conditions	Rheumatic Fever	Regular Headaches
Hospitalised Lately	Limited Activity	Muscular Pain or Cramps
A Hernia	Back Pain	Chronic Cough
High Cholestrol	Any Infections or Infectious Diseases

Declaration & Submission

I hereby represent to Runyaway Fitness Pty Ltd and associated companies, trust, partnerships and other legal entities, their directors, officers, employees, agents and affiliates that I am physically capable of and there is no medical reason to prevent me from processing with the use of the Club facilities without endangering my health. I acknowledge that whilst on the Club premises, my person, my guest, my property and my guests property are at my own risk. I acknowledge that I will not hold the Club responsible for and the Club hereby excludes, to the extent permitted by law, all liability for any personal injury or damage (whether direct, indirect, special or consequential) suffered by me or my guest or loss of property by me of my guest while I am on the Club premises or arising in any way out of the use the facilities and equipment provided by the Club, however that injury, damage or loss is caused, including if it is caused by negligence of the Club. I acknowledge that except as provided in this document the Club gives no warranties in respect of the facilities and equipment it provides. I hereby release and will indemnity and keep indemnified the Club for any injury or loss suffered by me while on the Club premises.

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