Membership Form

1. Full Name*
2. Gender Please select... M (Male) F (Female) X (Indeterminate/Intersex/Unspecified)
3. DOB*
4. Mobile Contact Number*
5. Email*
6. Street Address*
7. Suburb*
8. Post Code*
9. State*
10. Country*
11. Emergency Contact Name*
12. Emergency Contact Number*
13. Are you eligible for a concession (see list below)* Please select... Yes No

    Health Care Card, Seniors Card, Pensioners Card, DVA Card, Disability Access Card

14. Membership Type* Please select... Full Facility Gym Only Swim Only Group Fitness Only Shire Staff Member

    Please refer to our Memberships & Rate web page for pricing and inclusions.

15. Membership start date
16. Duration* Please select... 5 Day 7 Days (New members & Shire residents only) Fortnightly Direct Debit 1 Month 3 Month 12 Months
17. Cooling off period: This agreement is subject to a 7 day cooling off period, commencing the day of entering into the membership agreement. Cancellation of this membership agreement within the cooling off period must be received in writing. A $20 administration fee is applicable to all cancellations within the cooling off period. I agree
18. Ongoing membership agreement: This is an ongoing membership agreement. The agreement will continue until either you or the Margaret River Recreation Centre terminates it in the way described in the agreement. If an automatic debit arrangement is in place, membership fees will continue to be debited from your credit card or account until you or Margaret River Recreation Centre cancels the membership arrangement. If you terminate the agreement or stop the automatic debit arrangement in a manner not described in the agreement, then you may be liable to the Margaret River Recreation Centre for breach of contract. I agree
19. Membership Cancellations: All cancellations must be received in writing. A minimum two (2) weeks notice is required. Cancellation requests can be emailed to recreation@amrshire.wa.gov.au, or submitted via the online form on our website. Confirmation of cancellation will be acknowledged by return email. I agree
20. Membership Holds (Direct Debit Memberships):: Memberships may be placed on hold for a minimum of TWO weeks and a maximum of EIGHT weeks within a 12 month period. You are required to complete a suspension form (available on our website) in advance before the requested time period. I agree
21. All Members • Membership cards must be presented on every visit to the Centre. Entry may be refused if a Membership card cannot be presented or is not current. • Members cannot utilise mobile phones for the purposes of taking photos in any gym areas or change rooms. • All Members must complete a pre Exercise Screen before participating in any exercise activity within the Centre. • Membership commences from the date of purchase and/or Contract signed, unless otherwise approved. • Memberships are not refundable unless by medical practitioner advice or other extenuating approval granted by Management. • Transfers of memberships are available to members. Transfers incur a transfer fee, conditions apply. • All Members must always be dressed appropriately. This includes appropriate footwear, i.e. joggers. Thongs or sandals of any description will not be permitted entry for safety reasons. Patrons must wear enclosed shoes. • Members cannot be guaranteed a place in the group exercise classes, as numbers are limited for safety reasons. For safety reasons members may not be allowed entry into classes after advertised start time. Members are advised to arrive 10 minutes before the commencement of the class. • Management reserves the right to adjust the group fitness timetable at any time. • Margaret River Recreation Centre (MRRC) takes no responsibility for any personal belongings left in lockers or storage areas provided. • Members are required to remove personal items from change room lockers prior to the end of staffed operating hours. • Memberships are refundable if cancelling within 7 days of joining however any joining or administration fee is not refundable. Direct Debit (DD) Memberships • Fortnightly and Pay as You Go (PAYG) memberships abide by separate terms and conditions as detailed below. • MRRC requires 48 hours written notification of any changes to the membership (including cancellations and suspensions) to action these changes. • DD Memberships have no minimum term. You may cancel DD Memberships at any time, however the joining or administration fee is not refundable. The first payment of DD memberships must be paid upon joining. • DD payments made in advance will not be refunded and can only be cancelled on the next scheduled anniversary date. • Memberships continue indefinitely until the member notifies the MRRC to cancel in writing. Cancellation forms are available online. Ongoing Agreements – Direct Debit Memberships Only • The agreement will continue until you or the Margaret River Recreation Centre terminates in the way described in the agreement. • If an automatic debit arrangement is in place, membership fees will continue to be debited from your credit card or account until you or the Margaret River Recreation Centre cancels the arrangement by notifying you in writing, or your bank or credit provider. If you terminate the agreement or stop the automatic debit arrangement in a manner not described in the agreement, then you may be liable to the Margaret River Recreation Centre for damages for breach of contract. • I acknowledge that I have received and read the terms and conditions for automatic deduction memberships, the terms of which I agree to observe and be bound by should my application be accepted. • Direct debit memberships are subject to an annual price change. This will be advertised via the Shire’s Schedule of Fees and Charges available on the Shire’s website. Every effort will be made to notify members in advance via email notification where possible, and signage at the MRRC. Administration Fees • A joining fee applies to direct debit memberships. • If renewing your membership within (1) month of expiry no joining fee applies; however, re-joining after this period the joining fee will be charged. On-Hold Periods • All on-hold applications must be submitted to MRRC 48 hours prior to commencement of suspension period in order for MRRC administration staff to process the application. • MRRC staff cannot backdate on-hold applications. You must submit a separate on-hold application to MRRC for any extensions on current holds or normal pay schedule will recommence once the on-hold period has expired. • 1 Month PAYG memberships are not entitled to suspensions, with the exception of medical evidence. • MRRC Direct Debit Memberships are entitled to a maximum 12 week (accumulative) suspension period per 12 month period; and a minimum 2 week suspension period. • MRRC 3 & 12 Month are entitled to a maximum of 1 week and 4 weeks respectively per membership term. Operation *Normal operating hours are those hours in which there are staff on duty within the MRRC. • Members without membership cards may be refused entry. • Members who owe outstanding fees will be refused entry and asked to pay outstanding amount during normal operating hours • Members seen to be under the influence of alcohol will be refused entry • Members are not permitted to utilise any free or promotional passes outside of normal operating hours Hygiene • Towels must always be used on equipment. Towels may be available for sale from reception for a fee. • As a courtesy to other members, body deodorant is recommended. • Members are requested to keep door closed when using shower cubicles. Recommendation • As per Fitness Australia standards it is recommended that all males over the age of 35 and females over the age of 45 have a medical assessment including an exercise ECG and cholesterol. • Always read any exercise advice carefully. • It is highly recommended that you ask a staff member to guide you into the most suitable class or program. • Work at a low level on your first visit and concentrate on learning to do the exercise correctly. • Be sure to limit yourself to a pace where you can still talk comfortably. • Should you suffer any illness or condition in the future, please tell us so that we may update your files / program and take the opportunity to advise you appropriately. INDEMNITY CLAUSE “I recognise that participation in this activity involves the risk of injury to my person or my property. I acknowledge that whilst I participate I do so at my own risk. I will not hold the Shire of Augusta Margaret River, it’s staff, management, members, servants, or agents liable for any personal injury or loss of property that I may suffer whether caused by negligence or omission of any of them. I acknowledge that I have been given the option of choosing a membership based on a billing agreement, and have read, understand and agree with those direct debit billing conditions and associated fees.” I have read and fully understand the terms and conditions of membership on this application including the indemnity clause and I agree to abide by and accept these terms and conditions. I agree
22. Parent/Guardian Full Name*

    Must be completed if under 18. Parent/Guardian to authorise the Under 18 declaration below. N/A if 18 years or over.

If under the age of 18 years, parent/guardian must authorise*

Acknowledged

* denotes a required field.