Online Form - AQUATIC Membership

The Shire of Coolgardie offers an Aquatic Facility in each town site of Coolgardie and Kambalda.

Please click here for full terms and conditions


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Client may terminate their membership within 7 days; after the day on which the client enters into the agreement. Administration fees will apply at a pro rata rate to the term of agreement.

Family Members


AQUA Monthly
AQUA Flexi
AQUA Season

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Has any family member been a member of the Shire of Coolgardie gym?*
Is a new FOB, required? (This will be an additional cost) *



Has your Doctor ever told you or any family member that they have a heart condition or have ever suffered a stroke?*
Does any family member or you ever experience unexplained pains in their chest at rest or during physical activity/exercise?*
Does any family member or you have ever felt faint or have spells of dizziness during physical activity/exercise that causes them to lose balance?*
Has any family member or you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
Has any family member or you have diabetes, (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
Does any family member or you have any diagnosed muscle, bone, or joint problems that have been told could be made worse by participating in physical activity/exercise*
Does any family member or you have any other medical condition(s) that may make it dangerous to participate in physical activity/exercise?*


I understand that IF any questions answered are YES to any of the 7 questions above, I and /or family members should seek guidance from a GP or appropriate allied health professional prior to undertaking Physical Activity and/or Exercise.

I declare that I am, and/or named family members are medically and physically able to participate in physical activity and understand and accept the inherent risks of undertaking exercise.

I, or on behalf of family members, acknowledge and agree, that entry into the Facility and surrounds and/or participate in programs, utilise the equipment and/or take advantage of services offered by Shire of Coolgardie absolutely at each person’s own risk.

I, or on behalf of family members acknowledge that the Terms and conditions have been read and agree to observe and be bound by should this application be accepted.

I declare, to the best of my knowledge that all the information I have provided is complete and correct.