Registration Form

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MEMBER NAME

First

Last

DATE OF BIRTH

AGE

HOME PHONE NUMBER

WORK PHONE NUMBER

CELL PHONE NUMBER

EMAIL ADDRESS

RESIDENTIAL ADDRESS

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

TRN | IDENTIFICATION

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Please upload front & back of TRN or ID using the following format : "JPEG, PNG, DOC, PDF" file format

MEDICAL CONDITIONS

IF MORE THAN ONE MEDICAL CONDITION PLEASE GIVE LISTED CONDITIONS IN BOX PROVIDED BELOW.

ADDITIONAL MEDICAL CONDITION (OPTIONAL)

ALLERGIES

IF MORE THAN ONE ALLERGIE PLEASE GIVE LISTED CONDITIONS IN BOX PROVIDED BELOW.

ADDITIONAL ALLERGIES (OPTIONAL)

MEDICATION

CURRENT MEMBERSHIP STATUS

FAMILY DOCTOR

DOCTOR'S PHONE NUMBER

MEMBERSHIP START DATE

FIRST PAYMENT DATE

MEMBERSHIP TYPE (OPTIONAL)

EMERGENCY CONTACT NAME

First

Last

EMERGENCY CONTACT PHONE NUMBER

MEMBERSHIP FEE WITHOUT

DETAILS

NOTES

Before signing this document, I have read, understand and herby agree to the terms and conditions of membership defined.

* A NEW EMERGENCY CONTACT SHEET MUST BE SUBMITTED YEARLY AND EVERY TIME INFORMATION CHANGES*

NOTICE

Classic Body Fitness Centre urges all members to obtain a physical examination from their doctor prior to using any exercise equipment or attending any exercise class. In recogntion of the possible dangers connected with physical activity. A member hereby knowingly and voluntarily waives any right or course of action of any kind whatsoever arising as a result of such activities. No form of liability may be accrued to CLASSIC BODY FITNESS CENTRE LIMITED, ITS OFFICIALS, AGENTS, EMPLOYEES OR INSTRUCTORS.

Today's Date

SIGNATURE (FULL NAME)

Please direct any inquiries to the office at Shop #1 Sydenham Commercial Centre 33 Old Harbour Rd Spanish Town, Jamaica

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