Senior Membership Registration

To view senior membership packages this form must be filled and your age and pertinent details must be verified.

How it works
First Name *
Last Name *
Email *
Phone *
Gender
Date of Birth *


Address

Street Address Line 1
Steet Address Line 2
City
Postal / Zip Code
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Emergency Contact

First Name *
Last Name *
Phone *


Identification Verifcation

Identification Card / Passport *
Maximum file size: 256 MB


Health Questionnaire

Do you have any existing medical conditions? *
e.g. Heart Disease, diabetes, hypertensions etc.
Medical Conditions
Are you taking any medication that might affect your ability to exercise? *
Medication List
If they impact exercise
Do you have any mobility or balance issues that we should be aware of? *
Balance Issues
Do you experience shortness of breath, chest pain, or dizziness during physical activity? *
Cardiovascular and Respiratory
Do you have joint or bone related issues that limit physical activites? *
Musculoskeletal Health
Have you ever been told that you should only do physical activity recommended by a doctor? *
Doctor Recommended Activity Only
Do you know of any other reason why you should not do physical activity? *
Any Other Reason
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Terms and Conditions *