| Bodyworx Fitness Centre

First Name

Last Name

Address

Phone - Home

Mobile

(if no mobile number, add home here)

Work

Email Address

Would you like to receive our monthly newsletter by email?

Yes

Date of Birth

Date Joined

Occupation

HFC Enterprises (Bodyworx Fitness Centre) is committed to providing a safe and healthy environment
for all customers.

Management's Commitments and Responsibilities to Health & Safety include:

We are committed to providing a safe and healthy environment for all. We will
Take all practicable steps to ensure the safety of members and others.
Provide a safe place to exercise, safe plant and equipment.
Ensure that members are shown how to use the equipment, and champion safe exercise methods
always.
Systematically identify and manage hazards within the facility.

Guest Responsibilities when using the facility:

Exercise in a healthy and safe manner that ensures that no action or inaction by you causes harm
to yourself or any other person.
Report immediately any unsafe condition, hazard, accident or incident to the facility manager by
telephone or email (numbers listed on sign at front door).
Follow all rules and use safety equipment provided – as appropriate and as directed.
Actively participate in, supporting and promoting health and safety in the facility and grounds.
Following the first visit with a fully inducted member, all visits will be charged to the Guest Famil

Emergency ProceduresI agree that know the emergency procedures for:

Fire
Earthquake
Medical Emergency

I know:

How to raise the alarm
What the evacuation procedure is
Where the assembly point is
Where the emergency exits are
Where the fire extinguishers and first aid kits are

In signing, I acknowledge that I have no medical or physical conditions that limit my ability to exercise, and I understand that I exercise at my own risk. I confirm that I have completed this induction and am confident in my understanding of the material. I am comfortable I have all relevant information required to keep myself and others safe.

Induction Component	Discussion Points
Policy	I have viewed the Facility Rules and Regulations and know where to locate it.
Guest Responsibilities	I understand my health and safety responsibilities. I understand if I have concerns about the safety of myself or others, I must bring them to the attention of the facility manager as soon as possible by phone or email My first visit must be with another fully inducted member over the age of 18 who will sign the induction form as being responsible for my guest membership and will also be responsible for payment of any fees incurred.

Induction Component

Discussion Points

Policy

I have viewed the Facility Rules and Regulations and know where to locate it.

Guest Responsibilities

I understand my health and safety responsibilities.
I understand if I have concerns about the safety of myself or others, I must bring them to
the attention of the facility manager as soon as possible by phone or email
My first visit must be with another fully inducted member over the age of 18 who will
sign the induction form as being responsible for my guest membership and will also
be responsible for payment of any fees incurred.

I accept the above statements

I have carefully read and agree to the above statements

By checking this box, I acknowledge that I have no medical or physical conditions that limit my ability to exercise, and I understand that I exercise at my own risk. I confirm that I have completed this induction and am confident in my understanding of the material. I am comfortable I have all relevant information required to keep myself and others safe.