APPLICATION FORM

ARJUN FITNESS CLUB
Form No.

E-5, Bittan Market, Arera colony, Bhopal-462016, Tel. 420513
(Application form shall be submitted within 15 days from the date of issue)
Receipt No.
Date

Form fee Rs. 100/
Sig. Account Clerk
Event
Photo

Preferred Time slot

Swimming
Squash
Fitnees Cell
* Gym

* Fitness

* Aerobic

*Yoga

Name _____________________________ Surname _____________________________________
Father / Husband / Guardian Name _____________________________________________________
Address__________________________________________________________________________
Date of Birth______________________ Age ______________ Sex : F

M

Phone: Resi. _________________________________off. ___________________________________
Occupation _______________________________________________________________________
Activity- Individual, Family (Swimming / Squash / Fitness)

Signature of Applicant

MEDICAL CERTIFICATE
It is to certify that Mr. / Ms.__________________________________________________________
is medically examined by me. He/She is no suffering from any catagious decease or epilepsy. He/She is fit
for above activity

Blood Group

Signature, Seal with Registration no. of
Authorised Medical Officer

L LOSS OF LIFE CAUSED IN THE PREMISES OF FITNESS CLUB. Receipt No. Rs. * MEMBERS ARE ADVISED NOT TO BRING ANY VALUABLES. * MANAGING COMMITTEE RESERVES THE RIGHT TO CANCEL ANY MEMBER SHIP IF SO WARRANTED. * MEMBERS ARE REQUESTED TO CO-OPERATE WITH MANAGEMENT FOR BET TER SERVICES. Signature of applicant FOR OFFICE USE ONLY Recd._____________________(in words) __________________________________________ ON ACCOUNT OF MEMBERSHIP FEES+OTHER CHARGES. * MANAGEMENT SHALL NOT BE RESPONSIBLE FOR ANY ACCICENT INJURY. I hereby declare that I have read the rules & regulation of the Arjun fitness Club and do swear that I/ my family will abide by them. __________________________________Date ___________________ Time slot allotted Singanature of Account clerk . CHILDREN BELOW 5 YEARS ARE STRICTLY PROHIBITED. * MEMBERSHIP FEES NON-REFUNDABLE / NON TRANSFERABLE. * ENTRY ISIDE THE POOL IS PERMITTED ONLY WITH SWIMMING COSTUMES AND AFTER A SHOWER. * THE FITNESS CENTRE SHALL BE FUNCTIONAL AS PER SPECIFIED CLENDER. * VISITORA ARE NOT ALLOWED.GENERAL RULES & REGULATION * RIGHT OF ADMISSION RESERVED. THE MANAGING * COMMITTEE SHALL NOT BE RESPONSIBLE FOR ANY THEFT / LOSS.

They are not suffering from any catagious decease or epilepsy. / Ms./Ms__________________________________________________________________________ Mr. They are fit for above activity Signature. of Authorised Medical Officer . Bittan Market. Bhopal-462016. Arera colony./Ms __________________________________________________________________________ are medically examined by me. Seal with Registration No. 420513 Name Age 1) _________________________ Relation __________ Blood Group 2) _________________________ Photo __________ Blood Group 3) _________________________ Photo Photo __________ Blood Group Photo MEDICAL CERTIFICATE It is to certify that Mr.__________________________________________________________ Mr. Tel.APPLICATION FORM ARJUN FITNESS CLUB E-5.