Theodore Gym Membership Form

Theodore Gym Membership Application

To apply for gym membership please complete all questions.
Member Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Post CodeCountry
Member Contact Number
Format: (000) 000-0000.
E-mail
example@example.com
Member Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Member 2 Name (Family Membership only)

First NameLast Name
Member 2 Contact Number (Family Membership Only)
Format: (000) 000-0000.
Member 2 E-mail (Family Membership Only)
example@example.com
Member 2 Date of Birth (Family Membership Only)

DayMonthYear
2 digit day, 2 digit month, 4 digit year
Membership Type
Payment Options-
Please read Theodore Community Link Gym Users Policy, Rules and Regulations below before completing your application.
Do you have any medical conditions? (Asthma, Diabetes, Pregnancy, Heart). Please list.
Have you had any recent surgeries or injuries? (Back, neck, heart, reconstructions...)
I agree to be bound by the Policy, Rules and Regulations of Theodore Community Link Incorporated Community Gym. I am aware that I can ask for a copy of these policies, rules and regulations at any time. I acknowledge that it is recommended that I receive a gym orientation session and a health check/screening session before commencing work in the gym.

I understand if I pay by credit card, I am signing up to a subscription payment. Please contact the coordinator if you need to pause or cancel your membership.
If you need to pay with an alternative method, please contact the Coordinator.
Date of Signature

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Signature
Any questions regarding membership please contact Theodore Community Link

Email coordinator@theodorelink.com

For urgent queries - 0438 438 492 - Nita

Membership Options

Should be Empty:

Theodore Gym Membership Application

Membership Options

Credit Card