Health & Safety Questionnaire

Regular physical activity has many health benefits, however, some people should check with their doctor before they start. When planning to undertake physical activity, you should start by answering the questions below. If you are in any doubt, consult with your G.P. before commencing exercise. Please read the questions carefully and answer them honestly by circling YES or NO.
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? YES / NO
2 Do you feel pain in your chest when you do physical activity? YES / NO
3 In the past month, have you had chest pain when you were not doing physical activity? YES / NO
4 Do you lose balance because of dizziness or do you ever lose consciousness? YES / NO
5 Do you have a bone or joint problem that could be made worse by a change in your physical activity level? YES / NO
6 Have you ever had any problems with your back? YES / NO
7 Is your doctor currently prescribing any medication for your blood pressure or a heart condition? YES / NO
8 Is there any family history of heart disease, stroke, raised cholesterol or high blood pressure? YES / NO
9 Do you suffer from diabetes/epilepsy/asthma? YES / NO
10 Are you pregnant, or have you given birth in the last six weeks? YES / NO
11 Do you have, or have you had any illnesses recently? YES / NO
12 Have you recently had surgery? YES / NO
13 Do you know of any other reason why you should not do physical activity? YES / NO
14 What are your aims for exercising?___________________________________________________________
15 Present and past activity levels, how often and what type?________________________________________

If you have answered ‘yes’ to any of the questions above, please can you give brief details: (We may require you to obtain written consent from your G.P. before agreeing to allow you to undertake any physical exercise in the gym) I have read and fully understood the Health & Safety Questionnaire. I confirm that, to the best of my knowledge, the answers are correct and accurate. I know of no reason why I should not participate in an exercise workout. I understand that I would be using the Health & Fitness facilities entirely at my own risk and waive any legal recourse for damages to myself or property arising from my participation. I have understood and answered all of the above questions honestly. I understand that I should not exercise if I feel unwell and that if my health changes I should inform my instructor.

SERVICE CONTRACT
Service provider name: IRONMIND FITNESS LTD

Description of membership/service to be provided and length of contract (Minimum period)
PLATINUM FULL ACCESS Membership - £135.00 per month
AGREEMENT OF TERMS

• I agree the pay the monthly subscription for the minimum period of 62 days to the service provider, in agreement with the terms and conditions as set overleaf.
• I have read the terms and conditions overleaf and acknowledge that a termination payment will be payable to the service provider if I breach the terms of this contract.
• I have received a copy of this contract.
• I agree to 62 days notice of rolling contract.
• This is not a credit agreement as regulated by the Consumer Credit Act.
• Following the minimum monthly subscription period monthly payments will continue until the monthly subscription is cancelled, following the cancellation procedure.
• I have understood and received details of my subscription package and can confirm I agree with my above choice of membership package and length of contract.
• I either agree to payments being taken on the 1st of each month for my subscription, by a third-party collection agency and I agree to keep all details up to date.

Terms of your Customer Contract

Period of Commitment – You are agreeing to subscribe monthly to the service provider and contracting to remain a subscriber for the minimum period shown ABOVE.
Termination of Service – During the minimum period of the contract you may cancel the contract only:
1. If we fail to maintain the standard of service you would reasonably expect or alter the operating hours unreasonably.
2. If you develop a medical condition which prevents you from using the services on an ongoing basis. This must be supported by written evidence from an appropriate medical practitioner.
3. If you move away from the area by a distance which we consider, at our sole discretion, to be too far to travel to the service for regular use. We shall require evidence the move has taken place.
4. If you lose your employment and are unable to keep up the repayments as a result. You must produce documentary evidence and initially we will be prepared to suspend payments for two months and review with you your financial situation thereafter.

Contract prices are subject to an increase. Changes to prices may occur during this contract period. A 30 day notice period for change will be given in writing in this event.

Termination Payment for Early Cancellation

If you are to cancel your subscription during the minimum agreed contracted period, other than in the above circumstances, we shall be entitled to a termination payment. This consists of:
1. The arrears, if any.
2. Any accumulated late payment charges that have been or will be incurred.
3. The monthly subscriptions that would otherwise be due before the end of the minimum contracted period.
4. Should you wish to terminate early you can choose to pay 50% of the remaining subscription in one payment, this will end our agreement and the service we provide
Missing Payments – If there is one payment missed you are deemed to be in breach of your contract. We will contact you initially in writing to retrieve the termination payments, following court proceedings if recovery is still necessary.
Cancellation Procedure – IronMind Fitness will continue to collect your monthly subscription after the minimum contract period. Should you not wish to continue subscribing after the minimum period you must give notice to cancel the contract two months before the final payment of the minimum period. Should you wish to cancel the contract any time after the minimum contract period you must give 62 days notice. This notice should be in writing and sent to IronMindfitness2.0@gmail.com

If you fail to make a payment on time you will incur the following charges:
1. Fail to pay subscription on the due date £40.00
2. Fail to pay the missed subscription within 7 days of the reminder letter an additional £40.00
3. Fail to pay the arrears and accrued charges within 7 days of the date of final notice, you will be liable for additional charges plus missing contracted payments.
Late payment charges become payable immediately once they have been incurred.

Freezing Policy

In order to freeze your subscription a request must be submitted 30 days in advance of your next payment, in writing to ironmindfitness2.0@gmail.com to ensure the freezing is effective from the following month.
• You can freeze your subscription once per year at any time for a fee of £35.00 per month. The freeze is activated at the start of the next billing cycle and can be requested in monthly increments of up to 3 months (Up to 9 months for pregnancy).
• To request a freeze, complete a freeze request form from IronMind Fitness staff and submitted in person.
• Following the end of your requested freeze period, your monthly subscription will automatically be activated to your original monthly subscription. The requested freeze period is not part of your minimum term agreement you will still be liable for the remaining period of your agreement.
Data Protection Statement – IronMind Fitness always uses personal information submitted by you in accordance with all relevant data protection legislation. By signing this form overleaf, you are in acceptance of the terms of the data protection statement. IronMind Fitness will use your personal information as follows:
1. The supply a service as requested by you including sharing of information with IronMind Fitness employees.
2. For administration purposes.
IronMind Fitness may also disclose details of your account to a debt collecting agency for collection and tracing purposes. IronMind Fitness may transfer its business assets (including information held) on sale or merger of its business.
The data protection Act 1998 gives you certain rights, including the right to request a copy of your information and to have inaccurate information corrected. Please contact the Data Protection Manager, IronMind Fitness LTD.

BY SIGNING THE ELECTRONIC AGREEMENT YOU AGREE TO THE ABOVE TERMS