AG FITNESS GYM Registration Form
Full Name
Date of Birth
Gender
Select Gender
Male
Female
Other
Address
Email Address
Phone Number
City
Membership Type
Select Membership Type
Monthly
Quarterly
Yearly
Pincode
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone
Do you have any pre-existing medical conditions?
Select
Yes
No
If yes, please specify:
Are you currently taking any medications?
Select
Yes
No
If yes, please specify:
Do you have any allergies?
Select
Yes
No
If yes, please specify:
Have you ever experienced any injuries or surgeries?
Select
Yes
No
If yes, please specify:
Physician's Name
Physician's Phone Number
What are your fitness goals?
Interested in Personal Training?
Select
Yes
No
How often do you plan to visit the gym?
Select
Daily
3-4 times a week
Once a week
Occasionally
Terms and Conditions
I agree to abide by the rules of AG Fitness Gym.
I am responsible for my safety while using the gym.
I release AG Fitness Gym from any liability for injuries.
Membership fees are non-refundable.
I consent to receive promotional emails from AG Fitness Gym.
I agree to the terms and conditions.
Register