Gym membership registration and health check

Welcome to Ara Institute of Canterbury Sports and Recreation Centre. Thank you for choosing us as your preferred gym facility provider.

Set out below is your application to become a member of the gym. Please ensure that the information you provide in your application is up to date and accurate to ensure your application is processed without delay.

Please note: the fields marked with (req) are compulsory.

Your Details

Date of birth

(Street, Suburb, City, Postal Code)


Please indicate if phone number is home, work or mobile.

Emergency Contact



Health/Medical History

Have you ever suffered from any of the following medical conditions?

Please note: If you have answered yes to any of the health/medical history questions in this section or have been asked to present a medical clearance certificate when previously Joining another gym, a medical clearance certificate will need to be obtained from your doctor proving it is safe to exercise.

The medical clearance certificate will need to be returned with this application before you are able to use the gym.

If so, please list names and dosages of each.

File must be no larger than 2MB
File must be either a PDF or JPG image.

Current Health status

1=low, 10=high

1=low, 10=high

Injury History

e.g. right calf strain

Membership Details

Please indicate the membership type that you are paying for


Payment (EFTPOS, Credit Card, Cash) can be made in person at:

Student Finance
Ara City Campus
Madras Street, Christchurch

Training Sessions: Personal Responsibility

I have read, understood, and agree to the Terms and Conditions accompanying this form

Terms and Conditions

Any personal information provided to Ara is covered by our policy which complies with the Privacy Act 1993 and incorporates the twelve Information Privacy Principles. If you have any concerns about privacy, please contact the Privacy Officer.

Your contact details will only be used by Ara to send you relevant information; they will not be forwarded to other organisations. If you no longer wish to receive messages from Ara, you may opt out from receiving further messages from us. Please send us a message to with "Opt Out" as the subject or telephone 0800 24 24 76.

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