Gym Safety

To ensure the safety and security of members and staff, the identity and health circumstances of all guests and visitors should be provided prior to admittance. This enables the staff to keep tabs on everyone who enters the gym and stay informed of their health conditions in case of emergency.

Sections of the Form

Client Information

The client should be asked to provide their full name, address, and contact information, as well as an emergency contact phone number. Clients will often be required to present a photo ID to confirm their identity. Confirming the client’s identity allows the gym to keep track of its members, collect unpaid fees, and may help protect the safety of other members if any issue arises.

Health Information

It’s important for the intake form to request the client’s basic health information, including:

Heart conditions
Physical ailments
Pregnancy
Medications

This information allows the gym to assess whether it’s safe for the client to use the gym’s facilities and can be referred to if the client experiences a medical emergency.

Membership

Although the details of a client’s membership will be drawn up in a separate contract, it’s a good idea to include a section that assesses the client’s membership needs and interests in personal training or group classes. This is especially useful if the client is a visitor or guest, as it allows the gym to suggest membership plans and classes in which they may be interested.

Sample

Download: PDF, Word (.docx), OpenDocument

GYM INTAKE FORM

DISCLAIMER: Thank you for your interest in being a client of [NAME OF GYM]. Information collected about new clients is confidential and will be treated accordingly.

CLIENT INFORMATION

Client Name: _____________________

Address: __________________________________________

Phone: _____________________ E-Mail: _____________________

How did you hear about us? _____________________________________________

Emergency Contact: _____________________ Phone: ______________________

HEALTH / PAR-Q FORM

Has your doctor ever said that you have a heart condition and should only do physical activity recommended by a doctor? ☐ Yes ☐ No

Do you feel pain in your chest when you do physical activity? ☐ Yes ☐ No

In the past month, have you had chest pain when you were not doing physical activity? ☐ Yes ☐ No

Do you lose balance because of dizziness or do you ever lose consciousness? ☐ Yes ☐ No

Do you have a bone, joint, or other health problem that causes you pain or limitations in movement? ☐ Yes ☐ No

Are you pregnant now or have given birth within the last six months? ☐ Yes ☐ No

Do you take any medications on a regular basis? ☐ Yes ☐ No
If so, what are the medications? ____________________________________________

Do you know of any other reason why you should not do physical activity? ☐ Yes ☐ No

If you marked “Yes” to any of the above, please explain in detail: ______________________________________________________________________

MEMBERSHIP

Please indicate the type of membership you require:
☐ Adult ☐ Student ☐ Disability ☐ Retired ☐ Family ☐ Couple

Membership duration:
☐ 1 Year ☐ 6 Months ☐ 3 Months ☐ 1 Month ☐ Drop-In

Are you interested in personal training or group classes? ☐ Yes ☐ No
If yes, please specify: ____________________________________________________

SIGNATURE

Signature: _____________________________ Date: ____________________

Printed Name: ____________________

Gym Intake Form