Start Strong with Newport Beach Athletic Club

Fill this application we’ll have all the documentation ready for you when you arrive, so you can do directly to join our facility. Our family club makes membership simple and affordable. There are no long term contracts. Jr.Men and Jr.Women are 27 years old and younger.

MEMBERSHIP APPLICATION

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Your Name (required)

Last Name (required)

Email Address

Cell Phone

Business Phone

Home Phone

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Date of Birth

Choose Your Membership

Mailing Address

City

State

Zip Code

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EMERGENCY INFORMATION

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First Name (required)

Last Name (required)

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Phone

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MEDICAL HISTORY AND HEALTH HABITS

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Today's Date

Date of Last Physical

Sex

Age

Smoker

How Long?

What is the present state of your health as you perceive it?

Physician

Phone

Answer the following to the best of your knowledge:

Have you consulted a doctor prior to joining this club?

Has your doctor said you have heart trouble?

Do you frequently suffer from pains in your chest?

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Do you have high blood pressure?

Do you have arthritis?

Do you any problems that might be aggravated by exercise?

Are you diabetic?

Are you pregnant?

Do you have any back problems?

Do you have difficulty with physical exercise?

Do you have a hernia or any other condition that may be aggravated by lifting weights?

Have had surgery in the last 12 months?

Are you taking any medications or drugs?

Do you have a hernia or any other condition that may be aggravated by lifting weights?

This form is intended for informational purposes only. It in no way represents acceptability to participate in any exercise activity. A consultation with your physician should be done before starting any exercise program.
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Your Initials

Adding your initials above and checking this box means you are accepting the Policies of the Newport Beach Athletic Club