Online Form - GYM Membership - Kambalda

The Shire of Coolgardie offers a gym in each town site of  Coolgardie and Kambalda.

Please click here for full terms and conditions

Maximum size of ALL attachments is 976.56 MB


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.


Casual Entry
GYM Monthly
GYM Flexi
GYM Active
Maximum size of ALL attachments is 976.56 MB
Have you been a gym member before? *
Is a new FOB, required? (This will be an additional cost) *



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


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

I understand that IF I answered YES to any of the 7 questions above, I should seek guidance from my GP or appropriate allied health professional prior to undertaking Physical Activity / Exercise at the Shire of Coolgardie Gym Facilities and that I require a medical clearance to be eligible to receive an exercise program prescribed to me by a qualified gym instructor.

I declare that I am medically and physically able to participate in physical activity, and understand and accept the inherent risks of undertaking exercise. 

I acknowledge and agree that I enter 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 my own risk .