Membership – MNBJJ

MNBJJ Membership Form

Title

Forenames

Surname

Date of birth

DD

MM

YYYY

Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Phone

Email

Consent to use your photograph*

Yes
No

Consent to receive First Aid*

Yes
No

Emergency Contact

Name

Relationship

Number

Medical Questionnaire

If you answer 'yes' to any of the following questions please check the appropriate box.

History of heart problems, chest pain or stroke?
High blood pressure?
Any chronic illness or condition?
Recent surgery in the pass 12 month?
Pregnancy (now or within last 3 months) ?
History of breathing or lung problems?
Muscle, joint, or back disorder, or any previous injury still affecting you?
Diabetes or thyroid conditioning?
Have you been tested positive to Covid -19 in the last 2 weeks?

Terms & Conditions

I understand that whilst every care will be taken to give safe instruction, I accept full responsibility and consider myself fit to exercise. I have answered all questions correctly and all medical and health considerations are noted above. Please note it is your responsibility to inform your individual instructor of any medical condition that may affect your health whilst under their instruction as the information declared on this form is not passed on to anyone.

*

I agree to the above Terms & Conditions

Direct Debit Details

Full membership unlimited classes £60 .We are now offering a membership discount from £60 to £40 monthly until all classes are back to normal. Your first month membership is paid on your first day at the gym, and will be collected via direct debt on the first of every month. Cancellation of Membership: You must give MNBJJ 30 days notice to cancel your membership or 7 days notice if you with to cancel by contacting your bank.

Name on the Account:

Account Number:

Sort Code:

Consent*

I agree to the monthly DD

Sign*

Date*