MEMBERSHIP FORM

All prospective members are required to complete this registration form

Member Type

Are you registering as:

An adult member On behalf of a junior member (16 or under)

Member Details

Full Name *

Title

Gender

Preferred Pronoun (optional)

Date of Birth *

Mobile No *

Address *

Town/City *

Postcode *

Email *

Emergency Contact

Emergency Contact Name *

Emergency Contact Number *

Relationship to Member (optional)

Health Questionnaire

This health screening helps us assess your readiness for exercise. Please share anything relevant — even if not listed. Completion is required for all new members.

Is there any history of cardiac problems in the family?

Have you ever had heart trouble and/or felt pain in your chest when exercising?

Have you ever been diagnosed with hypertension (high blood pressure)?

Have you ever been diagnosed with hypotension (low blood pressure)?

Have you ever been notified that you have high cholesterol?

Do you have any bone or joint problems such as arthritis or osteoporosis?

Do you suffer from lower back pain?

Do you suffer from a bleeding disorder or do you bruise easily?

Do you suffer from any neurological disorders? (e.g., Epilepsy)

Do you ever feel faint or experience dizziness?

Do you have diabetes or any other metabolic disorder?

Please add any further details

Membership Options

Membership is renewed on a monthly basis, payment is due in advance of each month by the 28th.

PAYG

£7

Adult Per Class

Popular

£40

Adult Monthly

Gym Only

£20

Gym Access Monthly

Payment Method

💵 Cash 💳 Card 🏦 Standing Order

Bank Details for Standing Order:

Warrior Combat Gym CIC
Account No: 67416530
Sort Code: 08-92-99
Payments to be made by 28th of each month for month ahead

Consent

Full Name (Block Capitals) *

Date

📍 51 South Road, Waterloo, L22 5PE

📧 info@warriorcombatgym.co.uk

🌐 www.warriorcombatgym.co.uk