Leisure Application Form - Links Country Park Hotel

Membership Options:

We have membership options to suit different lifestyles. Choose a single or family membership, you can pay monthly by direct debit or pay as you go, with the option on an annual membership giving you 2 months FREE.

Benefits of becoming a Amber Leisure Member

Your membership card doubles up as a Privilege card.. what does this mean? Visit any Mackenzie Hotels property and when you stay, wine or dine with us you collect points to use against a future visit.

Membership Options Information

Single Membership is for adults aged 16 years and upwards, please note that anyone between 16+17 years old has to be accompanied by a member over 18 years old.

Family Membership is for up to 2 Adults & 2 Children under 16 years of age.

Pay As You Go – a monthly commitment, payment must be made each month at reception without a break to not incur a joining fee.

Direct Debit – Payment taken automatically each month until the Direct Debit is cancelled.

Annual – 12 months for the price of 10 membership with payment made annually in advance.

Please note a joining fee of £25 for each new membership will be payable on your first month.

Please select a membership option

Member(s) Details

1st Members Details

Adult / Child

Adult Child

Date of Birth (yyyy-mm-dd)

Do you drink alcohol?

Yes No

If yes, how many units a week?

Are you a routine smoker?

Yes No, but I have a history of smoking No, not at all

Do you think you have a balanced diet?

Yes No

Would you say you're an active person?

Yes No

Do you currently excercise?

Yes No

2nd Members Details - (Only complete for FAMILY Memberships)

Adult / Child

Adult Child

Date of Birth (yyyy-mm-dd)

Do you drink alcohol?

Yes No

If yes, how many units a week?

Are you a routine smoker?

Yes No, but I have a history of smoking No, not at all

Do you think you have a balanced diet?

Yes No

Would you say you're an active person?

Yes No

Do you currently excercise?

Yes No

3rd Members Details - (Only complete for FAMILY Memberships)

Adult / Child

Adult Child

Date of Birth (yyyy-mm-dd)

Do you drink alcohol?

Yes No

If yes, how many units a week?

Are you a routine smoker?

Yes No, but I have a history of smoking No, not at all

Do you think you have a balanced diet?

Yes No

Would you say you're an active person?

Yes No

Do you currently excercise?

Yes No

4th Members Details - (Only complete for FAMILY Memberships)

Adult / Child

Adult Child

Date of Birth (yyyy-mm-dd)

Do you drink alcohol?

Yes No

If yes, how many units a week?

Are you a routine smoker?

Yes No, but I have a history of smoking No, not at all

Do you think you have a balanced diet?

Yes No

Would you say you're an active person?

Yes No

Do you currently excercise?

Yes No

Emergency Contact Details:-

Please provide details of the person to contact in the event ot a trauma or medical emergency.

Medical Contact Details:-

Have you had any recent injuries including fractures, muscle strains, ruptures or tears?
Do you have any heart conditions, history of heart conditions including hypertension?
Do you have any joint/muscular problems including arthritis, tendonitis or osteoarthritis?
Do you have any neurological disorders including strokes, multiple sclerosis?
Have you had any recent pain or soreness in the muscles caused by trauma or injury?
Do you or any of the proposed applicants have any history of back pain?
Do you or any of the proposed applicants ever feel faint or had severe spells of dizziness?
Do you or any of the proposed applicants currently suffer from any contagious disease/ illness?
Have you or any of the proposed applicants ever been advised by a doctor not to partake in exercise?
Are you or any of the proposed applicants taking regular medication?
Do you or any of the proposed applicants currently suffer from any circulatory problems? E.g varicose veins

Please Answer Yes, or No

Yes - Please use the box below to explain which question(s), you are answering yes to and the names of the applicant(s) the responses relate to. No - None of the above apply to any of the applicants on this application.

MEMBERSHIP TERMS & CONDITIONS

DECLARATION: All the information provided will be kept on file and we must be informed of any changes to any medical information. This information will be on file for health and safety purposes. environment.

Payment Terms

Payment must be made before your first use of the facilities and on the same date of each month thereafter. If payment has not been received you will not be able to enjoy the privileges of membership. Please always sign in at the Leisure Desk or Reception before using the swimming pool and gym.

Rules & Children

We must point out that anyone who wishes to uses the pool or gym does so at their own risk. Children under the age of 16 wishing to use the swimming pool must be accompanied by an adult/ guardian who will take full responsibility for their welfare and behaviour. (1 adult per two children ratio).

To use the gym you must be at least 16 years of age and if you are under 18 must receive a full induction and have parental consent signed off before you can do so.

We must be informed of any changes to the information that you provide on this form.

Please Tick to Accept The Membership Terms and Conditions

I CERTIFY THAT I HAVE ANSWERED ALL OF THE ABOVE QUESTIONS CORRECTLY AND TO THE BEST OF MY KNOWLEDGE. I ALSO CERTIFY THAT I HAVE NOT BEEN ADVISED BY A DOCTOR OR HAVE ANY MEDICAL CONDITIONS THAT WILL BE AGGRAVATED OR MADE WORSE BY PHYSICAL EXERCISE. I ALSO UNDERSTAND THERE IS NO LIFEGUARD SUPERVISON OF THE SWIMMING POOL AND NO SUPERVISION IN THE GYM. I UNDERSTAND AND ACCEPT THE EXPOSURE TO RISKS THAT MAY OCCUR DURING USE OF THE LINKS COUNTRY PARK HOTELS LEISURE FACILITIES. I ACCEPT THE RISKS THAT MAY OCCUR DURING EXERCISE AND ACCEPT FULL RESPONSIBILITY FOR ANY ACCIDENTS, INJURY THAT MAY OCCUR.I ACCEPT RESPONSIBILITY IN COMMUNICATING ANY PHYSICAL AND PSYCHOLOGICAL CONCERNS THAT MAY AFFECT USE OF THE LEISURE FACILITIES. I HAVE READ AND FULLY UNDERSTOOD WHAT IS INCLUDED IN THIS WAIVER AND BY KNOWING THESE FACTS I AGREE TO WAIVE AND RELEASE THE LINKS COUNTRY PARK HOTEL AND ITS EMPLOYEES FROM ANY RESPONSIBILITY, LIABILITIES OR CLAIMS OF ANY KIND ARISING OUT OF MY USE OF THE LEISURE FACILITIES. BY TICKING TO ACCEPT THIS WAVER I INDICATE THAT I AM AWARE THAT THIS IS A WAVER AND THAT I HAVE VOLUNTARILY AGREED TO ITS TERMS.

Parent or Guardian Consent For Persons Aged 16 to 17 Wishing to Use Leisure Facilities

For any young person under 18 years of age but aged 16 or 17. Children under 16 are not permitted in the gym at any time and must be supervised in the pool at all times. I confirm the information given is correct and I give permission for my child (aged 16 or 17) to use the Gym without supervision once a full induction has taken place by a member of the leisure team.

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GIFT VOUCHER

Amber Leisure Club - Application Form

Your Details

Membership Options:

Benefits of becoming a Amber Leisure Member

Membership Options Information

Membership Options

Member(s) Details

1st Members Details

2nd Members Details - (Only complete for FAMILY Memberships)

3rd Members Details - (Only complete for FAMILY Memberships)

4th Members Details - (Only complete for FAMILY Memberships)

Emergency Contact Details:-

Medical Contact Details:-

Health Questions

MEMBERSHIP TERMS & CONDITIONS

Payment Terms

Rules & Children

Parent or Guardian Consent For Persons Aged 16 to 17 Wishing to Use Leisure Facilities