ACU Active, North Sydney

ACU Active, North Sydney - Guest Register

Full Name *

Email *

Additional instructions for the previous question. Please use ACU Student / Staff email if possible.

Phone *

Reason for completing guest register? *

Gym Tour

Free Trial

Casual Visit

HDR Sign-Up

Veteran Sign-Up

Health Screen - do you suffer from any of the following? * (Maximum authorized answers: 14)

Arthritis

Diabetes

Epilepsy

Chest Pain

Back Problems

Heart Condition

High/Low BP

High Cholesterol

Muscle Tension

Sports Injury

Asthma

Liver/Kidney Condition

Heart Trouble

Bone/Joint Problems

None of the above

Are you taking any medications? Yes/No. If so please list below. *

Are you, or have you been recently pregnant? *

Emergency Contact: Name & Phone *

Disclaimer

By completing this form, you warrant that all information that you have provided is true and correct and there are no other matters you wish to disclose about your state of health. Medical Conditions: Prior to your use of the gym, please ensure you have accurately completed the health screen as part of this form. Risk Warning: You acknowledge your use of ACU Active facilities is entirely voluntary and that while every reasonable attempt is made by ACU to ensure services and facilities provided are safe, there are inherent risks in participating in physical activity and that accidents can happen which may result in personal injury or death to you. Such risks may arise out of physical exertion, use or misuse of equipment, bodily contact with other training participants and other risks and factors. You acknowledge that you wish to participate having taken in account this risk warning and accept it. Collection Statement – Privacy Act 1988 (Cth) ACU’s Privacy Policy contains information on how ACU manages your personal information including how ACU may use your personal information, who ACU may disclose Your personal information to, how you may access Your personal information, and have it corrected, and how you may raise a complaint regarding an alleged breach of the Australian Privacy Principles. ACU’s Privacy Policy is available here: (https://www.acu.edu.au/policy/governance/privacy_policy_and_procedure/privacy_policy). ACU collects your personal information for the purpose of administering and managing Your ACU Active Gym visit/s. If you do not provide your personal information when requested by ACU, then ACU may not be able to grant you admission to the gym. The ACU Active Gym database has integration enabled with ACU’s student and/or staff records database. If, at the time of online registration, you opt-in to ACU using the personal information held by ACU to populate the fields contained on your membership form, then you are agreeing to ACU using your Personal Information from those record databases for the purpose of administering and managing Your visit and verifying your employee / student status. This includes any updates you make to your personal information on those record databases from time to time. In addition to the types of disclosures outlined in ACU’s Privacy Policy, you acknowledge that ACU may disclose your personal information to emergency services and medical or health service providers (for example the police, a general practitioner or other medical professional, ambulance or fire brigade) or if ACU becomes aware of information suggesting you are a risk to yourself or others.

Consent to the terms and conditions of entry? *

Yes

Archived records can be found by switching the status filter from Active to Archived.

Auto submit on change.

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Chat

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Download

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Making a selection will automatically add the tag.

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Paste emails in the text box separated by a line or a comma.

Reloads page and filters by this entry

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This checklist cannot be deleted because it is used for a Group Registration or Group Re-Registration approval process.

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Changing the selection will update the form

Changing the selection will update the page

Changing the selection will update the row

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Click to get the previous slides then tab forward.

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Use arrow keys

Video conferencing link, new tab.

View my entire calendar or schedule.

You are attending this event.

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