PHOENIX COMBAT SPORTS, MARTIAL ARTS AND FITNESS


Membership Registration Form



MEMBER REGISTRATION FORM

(PARENT/GUARDIAN TO COMPLETE FOR MEMBERS UNDER 18 YEARS OF AGE)



Are you under 18 or over 18 ?
 I am over 18 years If I am under 18 years, this free trial registration will be filled out and endorsed by my parent or legal guardian

Please get your parents/guardian signature at the gym for competition of membership packages

Welcome to Phoenix - You have selected package.


Please Select Are you under 18 or over 18?


Are you under 18 or over 18 ?


 I am over 18 years If I am under 18 years, this free trial registration will be filled out and endorsed by my parent or legal guardian

Please get your parents/guardian signature at the gym for competition of membership packages

Welcome to Phoenix - You have selected package.



UNDERSTANDING MY MEMBERSHIP

 I understand and agree that I am responsible for my own medical, legal and insurance advice and any other advice that may inform my participation in this activity.
 I understand that I am required to abide by all Phoenix Combat Sports rules and regulations and the code of conduct applies to me. I also understand I am required to abide by all signs posted in the gym and instructions from the coaches and staff.
 I understand that all classes start on time and that I will arrive early for class to be ready on time. I understand that if I miss the warm up of the class, I will not able to train in that class.
 I understand my membership fees are payable whether or not I use the gym or attend classes.
 All memberships include an average of classes done each week, calculated quarterly. I am required to sign into every class/session I attend or do. The sign in computer will advise me of my average.
 I understand my ‘pay in advance’ membership is a product purchased in advance and when it expires my membership is no longer valid. I also understand I cannot suspend it, transfer it, extend it, or get a refund if I choose not to use it or something comes up in my life that no longer allows me to use it.
 I understand it is my responsibility to ascertain if I am of good enough health and fitness to attend the gym and if my medical conditions changes that I will advise a staff member and consult a doctor before recommencing training.
 I understand that Phoenix Combat Sports has strict rules, regulations and notices for health, safety and welfare of its members.
 I understand that in becoming a member of Phoenix Combat Sports, I must not contravene any of its rules, regulations or notices.
 I understand that in becoming a member of Phoenix Combat Sports, I must abide by all directions or instructions given to me by Phoenix Combat Sports, its coaches or members of its staff.
 I understand that Phoenix Combat Sports may at its absolute and unfettered discretion, cancel my membership at any time.
 I understand that Phoenix has the right to refuse membership to any individual.
 I understand I am responsible for any guests and that they are aware of and abide by Phoenix Combat Sports rules and regulations.
 I agree to have my photo taken for administration and identification purposes.
 By joining Phoenix Combat Sports I will automatically become an individual member of ACT Muay Thai Inc.
 PIA - I understand my ‘pay in advance’ membership is a product purchased in advance and when it expires my membership is no longer valid. I also understand I cannot suspend it, transfer it, extend it, or get a refund if I choose not to use it or something comes up in my life that no longer allows me to use it.
DIRECT DEBIT BILLING - all direct debit billing is through an external company called PaySmart and Phoenix Combat Sports authorises PaySmart to bill your account on their behalf.
 PAYSMART - I understand direct debit memberships attract a set up and transaction fee and I have been advised of these fees. A one off set up fee is payable to PAYSMART ($5.50) on initial debit. Each fortnightly debit also attracts a ($1.95) transfer fee. These fees are in addition to my membership fees.
 PAYSMART - I understand my ‘direct debit’ membership remains valid until I cancel it. I can cancel, in writing, on a cancellation form at Phoenix Combat Sports and I am aware this cancellation will take 5 business days to process. I can also cancel my ‘direct debit’ membership on line by filling out the online cancellation form and I am aware this cancellation will take 30 days to process from receiving my email.
 PAYSMART - Phoenix Combat Sports is entitled to increase my fees with Phoenix annual price rises, giving 2 weeks’ notice. I authorise Phoenix Combat Sports to vary the amount of my periodic payment accordingly.
 PAYSMART - I understand I can suspend my direct debit membership for a minimum of 4 weeks and a maximum of 3 months and that the suspension MUST be done in writing at Phoenix Combat Sports. I am aware my suspension will take 5 business days to process.
 PAYSMART - I understand I can adjust my membership category up or down, on request, in writing at the gym.
 PAYSMART - I am aware PAYSMART is contracted to collect membership fees from Phoenix Combat Sports members and that if my account has insufficient funds I will be charged for missed payments and if I default on my payments without cancelling my membership, PAYSMART is authorised to initiate debt collection.
 PAYSMART - I am aware that Phoenix Combat Sports can refuse my application to use direct debit as a payment option.
 PAYSMART - Payments will show up as on your statement if paying by bank account as – ‘Phoenix FFA Paysmart’ and if paying by credit card as – ‘FFA Paysmart Kedron’.

 

Full Name
Date Of Birth
Sex
Male Female 

 
Have you previously trained / been a member of Phoenix? YES NO 
When

Email address
How did you hear about us?

Address
Suburb
State

Post Code
Phone (H)
Mobile

Emergency Contact Details
Name
Phone

Relationship

ACTIVITY SAFETY QUESTIONNAIRE
For your safety, please answer the following questions: Have you ever had or do you have:
1 High blood pressure or high cholesterol? Yes NO 
2 A heart condition/stroke/chest pain? A family history of heart disease, stroke or raised cholesterol? Yes NO 
3 Stomach ulcer/gout/liver or kidney condition/hernia Yes NO 
4 Epilepsy/diabetes/rheumatic fever? Yes NO 
5 Breathing difficulties or asthma? Yes NO 
6 Arthritis/back pain/muscular pain or cramps? Yes NO 
7 Any major injuries? Yes NO 
8 Are you on prescribed medication? Yes NO 
9 Have you been in hospital recently? Yes NO 
10 Do you have or have you had any infectious diseases or infections? Yes NO 
11 Have you sought medical advice before commencing at Phoenix Combat Sports? Yes NO 
12 Do you suffer from Anaphylaxia? Yes NO 
Note: If you answered yes to the above, you must have your epipen or allerject with you at the gym.


If you answered YES to any of the questions above, please advise the instructor and explain:

Please advise the instructor
MEMBER INDEMNITY FORM
1. Participant’s right to seek information and legal advice:

 This is an important document which affects the Participant’s legal rights and obligations. The Participant should read it carefully and not sign it unless satisfied that he/she understands it.
 If the Participant has any questions or requires any information about this form and/or the Activity the Participant is entitled to seek clarification from a staff member.
 The Participant is entitled and encouraged to seek legal advice before signing this form and the Activity Provider recommends that he/she does so.
 Participant to sign here to confirm that he/she has been advised of his/her right to seek information and legal advice and has been given the opportunity to do so.
 Participant to sign here to confirm that he/she has participated as an audience member and watched one Activity and acknowledges and accepts the way in which classes are conducted and the associated risks of the Activity.
 In the event the Participant does not participate as audience member pursuant to clause 3.5, the Participant and Legal Guardian agrees that they have voluntarily denied their right to participate as an audience member prior to participating in an Activity. Participant and Guardian to sign here if Participant has waived his/her right to participate as an audience member prior to participating in the Activity

2. Definitions: In this document the following words have the following meanings ascribed to them:

 Activity: Includes but is not limited to: Boxing, Muay Thai, Brazilian Jiu Jitsu, Grunt Fit, wrestling, any form of mixed martial arts (MMA) including group or personal training, and own training together and separately referred to herein as the “Activity” at any Phoenix Combat Sports Gym facility or provided by Phoenix Combat Sports Pty Ltd at any location.
 Activity Provider: PHOENIX COMBAT SPORTS PTY LTD (ACN: 006 586 661) including: Phoenix Combat Sports Gym, Phoenix Promotions, Phoenix Training Systems Pty Ltd, ACT Muay Thai, Phoenix Muay Thai and their agents, volunteers, coaches and staff.
 Legal Guardian: The person described at clause 2 above.
 Participant: The person described at clause 1 above.
 Phoenix Gym means Activity Provider.
 Risk Warning Acknowledgement and Assumption of Risk Release and Indemnity means this document and its annexures.

3. Acknowledgement by Participant:

The Participant acknowledges and understands:
 That the Activity the Participant is to undertake is a dangerous recreational activity and may involve a significant risk of physical or mental harm; and
 That by participating in the Activity the Participant is exposed to a wide range of risks and the possible consequences of those risks; and
 That the Participant is not required to engage in the Activity and does so of the Participant’s own volition; and
That whilst participating in the Activity:
 The Participant may be injured, physically or mentally, or may die; and/or
 Other persons assisting with or participating in the Activity may cause the Participant injury; and/or
 The Participant may, in consequence, suffer considerable financial consequences; and
 Notwithstanding the foregoing possibilities the Participant freely and voluntarily assumes the risk and responsibility for any injury, death or property damage or loss resulting in or from the Participant’s participation in the Activity.

4. Release of indemnity to the Recreational Activity Provider:

Except to the extent that the same may be precluded by law, the Participant agrees as follows:

 The Participant freely and voluntarily participates in the Activity at the Participant’s own risk and responsibility.
 The Participant has made his/her own enquiries and has satisfied his/her self as to the risks associated with the Activity.
 The Participant releases, indemnifies and holds harmless the Activity Provider, its servants and agents, from and against all and any actions or claims which may be made by the Participant or on the Participant’s behalf or by other parties for or in respect of or arising out of or incidental to the Activity, including any claim arising out of any injury, loss, damage or death caused to the Participant or the Participant’s property whether by negligence, breach of contract or in any way whatsoever or any liability that results from the breach of an express or implied warranty that the Activity will be rendered with reasonable care or skill.
 In the event that the Participant is injured, or the Participant’s property is damaged, or the Participant suffers any loss in consequence of or incidental to the Activity, the Participant will bring no claim, legal or otherwise, against the Activity Provider in respect of that injury, or damage, or loss.

Legal Guardian (Only required if participant under 18 years of age)

Full Name
Relationship to Participant
Address:
Phone:
Date of birth:
 I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*