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YMCA Cheltenham Sports Centre Membership Application

YMCA Sports Centre Membership Registration

Step 1 of 4

25%

Membership Information

Name(Required)
Date of Birth(Required)
Gender(Required)
Max. file size: 2 MB.
  • There should only be 1 face in the photo
  • The face is not too small compared to the image dimensions
  • The face is not blurry
  • The image is not too dark
  • The face has a neutral pose
  • It is a recent photo
  • No hat, no sunglasses
  • Full-on front face view, no profile views

Contact Information

Address(Required)

Emergency Contact (Next of Kin)

Please provide details of the person you would like us to contact in case of emergency.

Privacy Policy

Consent(Required)
The information you enter into this form will be collected and stored by YMCA Cheltenham. Please tick the box below to confirm you understand.

We will never share your personal details with anyone else and we will always store your personal details securely. We will only use them to provide the service(s) that you have requested and to communicate with you in the ways you have agreed to. For full details see our privacy policy.

Physical Activity Readiness Questionnaire

Has your doctor ever told you that you have a heart condition?(Required)
Do you suffer from shortness of breath or chest pain when partaking in physical activity?(Required)
Do you have Diabetes or Epilepsy?:(Required)
Do you suffer from dizziness or fainting?(Required)
Do you have arthritis or bone/joint problem that could be made worse by exercise?(Required)
Do you suffer from asthma?(Required)
Are you pregnant or have recently given birth?(Required)
Have you ever been told to only exercise under the recommendation of a doctor?(Required)
Do you suffer from back pain?(Required)
Do you smoke?(Required)
Do you exercise regularly?(Required)
Are you currently taking any prescription medications?(Required)
Assumption of Risk(Required)
"I hereby state that I wish to participate in activities which include, but are not limited to, aerobics, cycling, running and gymnasium exercise (aerobic and resistance) and stretching exercise. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me. I have had the opportunity to ask questions prior to exercising and they have been answered to my satisfaction."

Member's Declaration

Member's Declaration(Required)
"I agree to abide by the conditions of membership as laid down by the Board of Directors, and its appointed officers, and I accept that these may be changed from time to time. I agree that this information is being held on a computer system for use in accordance with the provision of the Data Protection Act. I have read and agreed to the statement titled Assumption of Risk. I have completed the Physical Activity Readiness Questionnaire before participating in an physical activity. In the event of an accident or illness, I give my permission for YMCA staff or volunteers to provide emergency first aid should the need arise."
Date
Consent(Required)

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Registered Office:

YMCA Cheltenham
6 Vittoria Walk
Cheltenham
Gloucestershire
GL50 1TP

Cheltenham YMCA is a company limited by guarantee
Registered in England No 3930834
Registered Charity No 1079951
HCA PRP No H4270

 

YMCA England
YMCA enables people to develop their full potential in mind, body and spirit. Inspired by, and faithful to, our Christian values, we create supportive, inclusive and energising communities, where young people can truly belong, contribute and thrive.
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