Seniors Club Membership

The Shire of Coolgardie offers Seniors Club Memberships. 

Please click here for full terms and conditions.

MEMBERSHIP COOLING-OFF PEROID, members 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.

Eligible concession rates are offered to Health Care Card, Pension Card holders, Dept. of Veterans Affairs and Seniors Card holders.

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Have you been a gym member before?*This field is required.
Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx
EMERGENCY CONTACT DETAILS

Emergency Contact: A person to be contacted in the event of an emergency. This section should contain the emergency contact's details only and should not include or duplicate the client's personal information.

PRE-EXERCISE SCREENING
Has your Doctor ever told you that you have a heart condition or have ever suffered a stroke?*This field is required.
Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?*This field is required.
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*This field is required.
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*This field is required.
If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*This field is required.
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? **This field is required.
Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise? **This field is required.
AGREEMENT TERMS AND CONDITIONS

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 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. 

ACKNOWLEDGE TERMS AND CONDITIONS*This field is required.