Name: Seniors Pass (upfront)
SKU: 214328
Price: 144.00 AUD
Availability: OutOfStock

Today's Date*

Name*

First Last

Email*

Phone*

DOB*

Preferred Method Of Contact

Email
Telephone

What are you interested in?*

Outdoors Group Training
Virtual / Zoom Training
Both

What do you want to achieve by exercising?

Weight loss / fat loss
Improve Fitness
Gain self esteem / improve self esteem
Support emotional health (anxiety)
Gain more energy
Tone up / get stronger
General wellbeing / fitness
Have fun & meet new people

Do you have any previous, or existing injuries, joint complaints, or medical conditions?

Please mention below:

Are you currently exercising?

Yes
No

Share with us more of your goals, concerns, questions and how we can help you:

Membership Terms & Conditions

All memberships are an ongoing recurring weekly (direct debit) or upfront term payment. Memberships are a 10 week/ term commitment and can only be changed / cancelled after the 10 week term is complete.

Signature & Date Please:

Name

This field is for validation purposes and should be left unchanged.

A. If you are a new client firstly, please fill out our health questionnaire below. If you are an existing client, please proceed straight section B. below:

Membership Terms & Conditions

B. Secondly, lets set up your payment details:

Seniors Pass (upfront)