Membership Application & Payment Record Sheet
Name: _____________________________ Tel: _______________________
D.O.B ________________ Age: _______ (Min Age is 16yrs – proof is required)
Address: ______________________________________________________
______________________________________________________
E-Mail
Where did you hear about Newman sport centre? ___________________
Type of membership:
Newman Student:
Monthly £20  Quarterly £45 6 Months £75

Newman Staff:
Monthly £20  Quarterly £45  6 Months £75

Valid Student and Staff cards must be shown to a member of staff
Community:
Monthly £25  Quarterly £60  6 Months £100 
Opening Times:
Student & Staff Access*: Monday – Friday 7.00am - 10.00pm (Closure between 11.00am – 11.30am)
Community Access:
Monday – Friday 3.00pm - 10.00pm
Saturday 10.00am-5.00pm Sunday 10.00am-3.00pm (Students, Staff & Community)
Please note we are closed Bank Holidays and other closure periods will be displayed around the centre.
*Term time only.
Newman Sport Centre number: 0121 483-2286
Dates: Commencement: _________________ Expiry: _________________
Induction: ____________________  Date of induction ____________ 
Cheque Payments:
Cheque Number ____________________________ Amount £___________
Cheque card number ____________________________ Expiry Date_______
Name on cheque __________________________________
Cash Payments:
Amount paid £__________
Members Signature ____________________________________
Cashiers name __________________________________ Date ____________
Cashiers signature ______________________________________
Physical Activity Readiness Questionnaire (PAR-Q)
Name:_________________ Date______________
For most people physical activity should not pose any problems or hazards. PAR-Q has been
designed to identify the small number of adults for whom physical activity might be inappropriate or
those who should have medical advice concerning the type of activity most suitable for them.
Please read each question carefully and check yes or no opposite the question as it applies to you.
Completion will give you an idea if you should consult your doctor before starting an exercise
programme. Your doctor can advise you (and if necessary your trainer) as to appropriate types of
exercise and intensities that are best for you.
Yes
No
1. ____
____ Has your doctor ever said you have heart trouble?
2. ____
____ Do you frequently have pains in your heart and chest?
3. ____
____ Do you often feel faint or have spells of severe dizziness?
4. ____
____ Has a doctor ever said your blood pressure was too high?
5. ____
____ Has your doctor ever told you that you have a bone or joint problem such as
arthritis that has been aggravated by exercise, or might be made worse with exercise?
6. ____
____ Is there a good physical reason not mentioned here why you should not follow
an activity programme even if you wanted to?
7. ____
____ Are you over age 65 and not accustomed to vigorous exercise?
8. ____
____ Are you pregnant?
If you answered YES to one or more questions….
If you have not recently done so, consult with your personal physician/doctor by telephone or in
person before increasing your physical activity and/or taking a fitness test.
If you answered NO to all questions….
If you answered the PAR-Q accurately, you have reasonable assurance of your present suitability to
begin an exercise programme. You should


Begin slowly at low to moderate intensities and gradually build up.
have a fitness appraisal
Note:
1. You should delay embarking on an exercise programme if you are suffering from a
temporary illness, such as a cold.
2. If you’re health changes and your response to any of the above questions becomes ‘yes’ –
you should consult your doctor before continuing/embarking on an exercise programme.
Signature _____________________________________
Centre Policies
The centre reserves the right to revoke a facility membership without refund, of any user
that repeatedly or purposely does not adhere to the following regulations.
I, the undersigned, agree to comply with all policies and guidance set out in this document;
Please read and initial after each point:
1. All persons entering or using the facilities for whatever reason do so at their own risk.
2. All persons entering or using the facilities must abide by the policies and rules of the sports
centre, and any instructions given by the sports centre and sports department staff.
3. All accidents and/or incidents (including potential hazards e.g. spillages) must be reported
immediately to a staff member and recorded on an Incident Report Form.
4. All members must have a ‘Fitness Suite/ Weight Room’ induction prior to using these
facilities.
5. Any person under the age of 16years must be supervised at all times by their parent or
guardian.
6. Persons under the age of 16years are not permitted in the Fitness/Weight rooms.
7. The minimum age for Sports Centre membership is 16 years.
8. Appropriate clothing & footwear must be worn commensurate with the activities undertaken
(no work attire).
9. The Sports Centre is not responsible for the personal safety of users, or the security of their
possessions.
10. The Sports Centre may at times be unavoidably closed without notice - Sports Centre
members/users are advised to call the facility prior to undertaking any journey to check
access and availability of facilities. No recompense can be made on these occasions.
11. Items of equipment may at times be inoperable or unavailable; Sports Centre
members/users are advised to call the facility prior to undertaking any journey to check
availability of equipment. No recompense can be made on these occasions.
12. Items of equipment, accessories, etc. must not be removed from the facility or used in a
manner that is inappropriate, dangerous or that differs to the induction instructions.
13. Dropping of weights prohibited within the fitness and sports performance suite.
14. All equipment (e.g. dumbbells) is to be returned to their designated area after use.
15. No food, canned drinks or chewing gum to be allowed in the fitness and sports performance
suites.
16. Lockers must be used to store bags at all times.
17. Intimidating language or behaviour will not be tolerated and will result in the loss of
membership.
Name (Please Print): ______________________________
Signature: ________________________________
Date: ______________
DISCLAIMER/HOLD HARMLESS AGREEMENT
I, the undersigned, fully understand that I am responsible for monitoring my physical condition
throughout any activity undertaken at this facility. I understand that any exercise programme should
be designed to gradually increase the workload of my cardio-respiratory system and accept that my
reaction to the programme cannot be predicted with complete accuracy and that there is a risk that
adverse effects may be experienced during, or after, participation in the exercise programme,
including abnormalities of heart rate and/or blood pressure etc. Should any unusual symptoms
occur, I will immediately:
a) refrain from participation in the activity
b) Inform an appropriate member of staff of the symptoms experienced.
c) seek professional medical advice before resuming any exercise
I accept that I enter into any activity on the premises entirely at my own risk, and in the absence of
negligence on the part of the University, I will hold blameless Newman University its servants or
agents (including any independent contractor) for loss or damages resulting from, but not limited to,
death or injury incurred during or arising from any activity undertaken on these premises. I hereby
acknowledge that I may at times be using the sports centre facilities in the absence of any
supervisor or employee, and that the Sports Centre is not responsible for overseeing or instructing
me in the use of the strength & conditioning facility. I acknowledge that I have been advised of the
risks involved in the use of the Sports Centre (including the strength & conditioning facility).
I agree to comply with all rules relating to the use of the Fitness Centre, the equipment and
machines. I accept that the University reserves the right to ask any user to leave the premises, and
terminate their membership, without recompense, in the event of inappropriate behaviour, lack of
respect to the facility and for my own health benefit.
I understand that I must inform a relevant member of the facility of any subsequent changes to the
information originally provided in the Health Questionnaire.
I have read and fully understand the contents of this document. I accept full responsibility for my
own health/well being, actions and any physical or mental changes that might occur as a result of
my use of the Newman University Sports Centre.
Name (Print) ___________________________
Signed ________________________________ Date _________________