top of page

Under 16 Gym Membership form

Please complete this form to join our under 16 membership.  On receipt of this form, a member of staff will be in touch to arrange a start up plan with you. 

Date of Birth
Day
Month
Year

Accompanying Adult Details:

This is the adult who has valid West Calder Hub Gym membership and will be with the young person at all the times whilst they are within and using the fitness suite.

High cholesterol:
Yes
No

Have you ever suffered from high cholesterol?

Heart disease:
Yes
No

Is there any history of heart disease or heart trouble in the family?

Asthma:
Yes
No

Do you suffer from asthma?

Surgeries:
Yes
No

Have you had any surgeries in the past 3 years or attended hospital?

High blood pressure:
Yes
No

Do you have a history of high blood pressure?

Back pain:
Yes
No

Do you suffer from any knee or back pain?

Joint pain:
Yes
No

Do you suffer from any knee or back pain?

Muscles & ligaments:
Yes
No

Do you suffer from any muscle or ligament problems?

Fainting:
Yes
No

Have you ever felt faint or had spells of dizziness?

Epilepsy or diabetes
Yes
No

Have you ever been diagnosed with epilepsy or diabetes?

Photography consent
Yes
No
I confirm that I, as the adult gym membership holder, will
bottom of page