Gym Membership Form – Kogarah
Date of Birth
Address Line 1
State / Province / Region
Referrals and Promotions
Please select one
Refer a Friend - receive 2 complimentary weeks if you are referred by a current member*
I'm not interested
Terms and Conditions - Referral Program
I agree to the terms and conditions stated below
Available to new members only. Minimum 3 month period applies. If you wish to cancel during this period all fees must be paid in full.
Which Gym Membership would you like to purchase?
Pinnacle - Gym & Classes ($12 per Week)
Choice - Gym Only ($10 per Week)
Choice - Classes Only ($10 per Week)
10 Pass Fitness Classes and Gym ($140)
How would you like to pay?
Please select one
Salary Sacrifice (M or F Salary ID only)
If you'd like to pay through salary sacrifice you must have and ID code that begins with M or F.
I give permission for Pinnacle Health Group to deduct payments upon completion of this agreement.
Note: Payments will be deducted next payroll cycle. For Direct Debit, access will not be provided until Payment Form is completed
Do you have any allergies?
Please list any current medications:
Is there anything else we should know?
Are you pregnant? How long? Any Injuries? Surgery in the last 12 months?
I acknowledge that if I have experienced any of the below conditions I must seek professional advice before signing this agreement and receive confirmation that I am medically fit to participate in exercise. I also acknowledge that it is my responsibility to advise Pinnacle Health Group in writing of any relevant medical changes after signing this agreement.
(1) Suffered a stroke
(2) Unexplained chest pains at rest or during physical activity
(3) Experienced spells of dizziness during physical activity that caused me to lose balance
(4) Experienced an asthma attack requiring medical attention any time over the last 12 months
(5) Diabetic (Type I or II) who has had trouble controlling my blood glucose in the last 3 months
(6) Diagnosed with a muscle, bone or joint problem
(7) Any other medical condition(s) that may make it dangerous for me to participate in physical activity
TERMS & CONDITIONS
I acknowledge and agree to the terms and conditions of this agreement.
Welcome to the Kogarah Wellness Centre. To ensure that Pinnacle Health Group able to provide a safe and comfortable environment for all members and staff please assist us by ensuring that you comply with the following conditions. We advise you to only sign the membership agreement if you understand and agree with these conditions. The information outlined in these terms and conditions can / will be used in the event of a discrepancy.
By signing the agreement, you are agreeing to have been given a copy of this agreement and agree to abide by the rules of membership. You also acknowledge and agree that you are medically sound to undertake a normal course of exercise, you use the Wellness Centre facilities at your sole risk and responsibility and you are aware that exercise is physically demanding and participation in some activities may pose a risk to your health. This agreement also relates to the member’s authority to Westpac Banking Corporation to salary sacrifice, or Ezidebit Pty Ltd directly debit the nominated bank account or credit card for any instalments or fees due under the terms and conditions of this Agreement and Direct Debit Request. These terms are stated below.
In this Agreement unless the contrary intention appears:
a) The singular includes the plural and vice versa.
b) A reference to a party includes that party’s legal personal representative heirs and assigns.
c) "Member" refers to the name in which the membership account has been created, which at times may differ to the party paying for the membership.
d) "The Wellness Centre" and "Pinnacle Health Group" means "Pinnacle Corporate Health Group Pty Ltd (ACN 141 105 151)" trading as "Pinnacle Health Group" of 239 Punt Rd Richmond, Vic, 3121.
e) Home Wellness Centre access refers to the Pinnacle Health Group Wellness Centre named at the start of this agreement.
3. RECEPTION AND ACCESS
a) All members accessing the gym must swipe their membership token upon entry to the gym zone at every visit.
b) All members accessing the studio zone for classes must swipe their membership token at the card reader at reception before entering the studio zone.
c) Card replacement cost is $5.00 for small barcode key tags
d) All ‘guest visitors’ to The Wellness Centre are required to present to centre staff upon every visit
e) Entry to the Wellness Centre may be refused as a result of unpaid or outstanding membership fees.
f) Please advise us of any changes to your address and / or contact information.
4. GENERAL CONDITIONS OF ENTRY
To assist us in maintaining a safe and comfortable environment for all members and staff, please abide by the following conditions. Failure to abide by these conditions may result in the suspension or termination of your membership.
Entry will be refused or you may be requested to leave the Wellness Centre if:
a) You are using abusive or threatening language or behaving in a threatening way.
b) You are under the influence of drugs or alcohol.
a) The Wellness Centre is a non-smoking facility.
c. DRESS CODE
a) Fully enclosed, clean sports shoes must be worn during workouts for safety reasons.
b) Members are required to wear a singlet or t-shirt at all times in the Wellness Centre.
c) Clothing must be clean and tidy with no offensive prints or designs for the consideration of other members.
a) Please use a towel when participating in classes and when exercising on gym equipment to maintain hygiene and safety standards.
b) Towels are available free of charge at the entry to the gym, and in change facilities
c) Used towels are to be placed in the facilities provided.
e. PERSONAL TRAINING
a) Personal training services are available for use for an additional fee.
b) Please contact your Wellness Centre for more information
c) Payments for personal training should be made directly to The Wellness Centre
5. USE OF EQUIPMENT
a) For the safety of you and others, please follow all equipment operating and safety instructions on the equipment.
b) If you are not sure of correct use or operation of equipment, please seek assistance from a Wellness Centre team member.
c) We ask that you return weights and bars to their racks when you have finished with them. This includes unloading plates from machines and bars when you have finished. This also applies to equipment used in Group Fitness classes.
a) Lockers are available for use in the centre
b) Casual use lockers are available free of charge in the hallway of the Wellness Centre
c) Casual lockers are limited to 24-hour use only
d) Permanent lockers are available for hire inside change facilities. Please contact Westpac concierge for more details.
e) Please look after your personal items. The Wellness Centre, its employees, or contractors, are not responsible for any loss of personal property.
f) Please do not bring bags to the gym floor.
7. LOST PROPERTY
a) We highly recommend that you use lockers for your belongings.
b) The Wellness Centre does not take responsibility for loss or damage of your belongings.
c) Any items of lost clothing will be held for two weeks, and then donated to charity.
‘Pinnacle’ Membership at The Wellness Centre entitles you to:
a) Work out as many times as you wish in a given period.
b) Participate in scheduled Group Fitness classes.
c) Use of exercise equipment located on the gym floor and cardiovascular training areas.
‘Choice’ Membership at The Wellness Centre entitles you to:
a) Nominate to The Wellness Centre your choice of Gym or Class Access (not both)
b) Any changes to access choice must be requested by the member to the wellness centre
c) Work out as many times as you wish in a given period.
Membership at The Wellness Centre requires you to:
a) Update your contact details when they change so that we can keep in touch.
b) Comply with all Conditions of Entry (see Wellness Centre signage) and the guidelines in this document.
c) Pay all agreed fees, ensure sufficient funds are available to cover all fees and advise us in advance if your bank account or credit card is closed or changed.
d) Inform us in advance if there are any risks to your health if you participate in fitness services and if required seek approval from your Doctor or General Practitioner.
e) You acknowledge that it is your responsibility to cancel direct debit facilities in respect of your membership when this agreement expires or is terminated.
c. SPECIAL CONDITIONS REGARDING MEMBERSHIP ENTITLEMENTS
a) The Wellness Centre reserves the right to make changes to exercise equipment supplied in any of its Wellness Centres at any time.
b) The Wellness Centre also reserves the right to make changes to the Group Fitness timetable at any time. (ie. alter class type, times and instructors).
c) All entitlements and entry into The Wellness Centre is revoked if a member’s account is in arrears in excess of $40.00.
d) If your automatic direct debit reverses or is returned to us by your financial institution, we will attempt to contact you about retrying the debit. If the debit remains outstanding, it will be processed within 14 days of the reversal with any reversal and late fees that apply. If you fail to pay us the fees by the due date, we are entitled to refuse you entry to the Wellness Centre. If unpaid fees remain outstanding and after attempts by us to rectify the arrears, your membership may be forwarded to a collection agency for further action.
d. CHANGES TO CONDITIONS
a) The Wellness Centre reserves the right to change the conditions contained in Clause 9 by providing you with one-month advance written notice of any changes.
9. CANCELLATION / TERMINATION
This agreement is subject to a cooling off period. A cancellation request should be directed to The Wellness Centre.
a. DURING COOLING OFF PERIOD:
Your membership is subject to a 14 day cooling off period. The cooling off period starts from the date the agreement is entered into and ends at close of business 14 days later and may be terminated under the following conditions:
a) The Wellness Centre requires a written request to terminate the membership within the time frame specified as the cooling off period from signing the membership agreement.
b) All monies paid will be refunded with the exception of an administration fee of $59 if your Wellness Centre key tag and any merchandise you received on joining are not returned.
c) The Wellness Centre may request an additional payment to recover costs in relation to any fitness services provided to the member within this period.
b. OUTSIDE COOLING OFF PERIOD:
Your membership may be terminated at any time within the following guidelines:
a) The Wellness Centre requires a written request to terminate the membership with a minimum of 14-days notice to allow removal from salary sacrifice of direct debit arrangements.
b) An administration fee of $59 may be charged if your Wellness Centre key tag and any merchandise you received on joining are not returned.
c) The Wellness Centre may request an additional payment to recover costs in relation to any fitness services provided to the member that may be outstanding.
a) Suspensions are available for a minimum period of 2-weeks and a maximum of 6-weeks per year.
b) A suspension form must be completed in person at the Wellness Centre at least 14 days before the period requested and cannot be back dated.
11. PAYMENTS BY SALARY SACRIFICE
a) The member must indicate their preference to pay by salary sacrifice on the membership sign-up form
b) A valid salary ID must be given in order to qualify for salary sacrifice of membership payments.
c) If paying by salary sacrifice the Member agrees to pay the instalment amount at the agreed payment frequency until this Agreement is terminated in accordance with clause 9.
d) A Customer’s “personal information” (as that term is defined in the Privacy Act 1988 (Cth)) will only be used by The Wellness Centre, Westpac Banking Corporation Payroll to provide you with the services contemplated by this Agreement. Pinnacle Health Group’s Privacy Statement can be obtained from its website www.pinnaclehealthgroup.com.au.
e) Should there be any arrears in payments the Member authorises Westpac banking Corporation Payroll to debit the outstanding balance in order to bring the account up to date.
12. PAYMENTS BY DIRECT DEBIT
a) If paying by Direct Debit the Member agrees to pay the instalment amount at the agreed payment frequency until this Agreement is terminated in accordance with clause 9.
b) Should there be any arrears in payments the Member authorises Ezidebit to debit the outstanding balance in order to bring the account up to date.
c) Payments made via Ezidebit will be governed by Ezidebit’s terms and conditions, and privacy statements which can be found at ezidebit.com.au
13. ADMINISTRATION FEE (DIRECT DEBIT and SALARY SACRIFICE)
a) If paying by Direct Debit, a one-off fee of $59.00 is payable by the Member on signing of this Agreement.
a) A Customer’s “personal information” (as that term is defined in the Privacy Act 1988 (Cth)) will only be used by The Wellness Centre, Westpac Banking Corporation Payroll or Ezidebit to provide you with the services contemplated by this Agreement. Ezidebit’s Privacy Statement is to be found on its website www.ezidebit.com. Pinnacle Health Group’s Privacy Statement can be obtained from its website www.pinnaclehealthgroup.com.au.
15. DEBT COLLECTION AGENCIES
a) If paying by Direct Debit, upon default by the Member in regard to any obligation under this Agreement and failure to remedy the default after notification by Ezidebit, the Member authorises Ezidebit to notify any debt collection agency of the default.
b) Should this occur then at Ezidebit’s sole discretion it may terminate the Agreement at which time the full outstanding balance for the remainder of the minimum term or payments (including any current arrears) shall be due in full.
c) The Member authorises Ezidebit to add to the outstanding debt a fee of $50 and an amount equivalent to 25% of the full outstanding balance (being Ezidebit’s expenses reasonably incurred in collecting the debt) upon initial referral to the debt collection/credit reporting agency.
16. INCREASE IN FEES
a) If paying by Direct Debit or salary sacrifice, The Wellness Centre may at any time AFTER the end of the minimum term, upon sending written notice to the Member's last known address and giving 14-days notice, increase the instalment amount.
b) If the Member wishes to terminate this Agreement as a result of the increase in the instalment amount, the Member must notify The Wellness Centre / Ezidebit in writing within 14 days of the date of the written notice sent by The Wellness Centre. The Agreement will be terminated upon receipt of this notice.
c) If the Member does not notify The Wellness Centre of its intention to terminate this Agreement within such specified time period, then this Agreement will remain in force and the increase in the instalment amount will be deemed to be accepted by the Member.
17. ENTIRE AGREEMENT
a) This Agreement, the salary sacrifice agreement and the DDR Service Agreement (if paying by Direct Debit) constitute the entire agreement, understanding and arrangement (express and implied) between the Member, The Wellness Centre, Westpac banking Corporation Payroll and/or Ezidebit relating to the subject matter of this Agreement and supersedes and cancels any previous agreement, understanding and arrangement relating thereto whether written or oral.