Welcome to the online sign up for Harleston Community Leisure Facility.  Thank you for joining our leisure facility, we look forward to meeting you.  If you are under the age of 18 years old your parent/guardian must complete the membership agreement on your behalf,
please insert Childs name in the Unique Reference Field.

Harleston Community Leisure Facility Terms & Conditions External Link I have read and agree to the Terms & Conditions. *
Promo Code If you have a Promo Code, please enter it here:
Unique Reference No If you have a Unique Reference No, please enter it here:
How did you hear about us? *

Please Select your Membership Plan
6 Month Platinum (Unlimited Gym & Classes anytime) Membership - £31.00 p/m
Plus a Pro Rata payment, payable on first visit.
Month to Month Gold Membership (Unlimited Gym or Classes Only Anytime) - £26.00 p/m
Plus a Pro Rata payment, payable on first visit.
6 Month Gold Membership (Unlimited Gym or Classes Only Anytime) - £22.50 p/m
Plus a Pro Rata payment, payable on first visit.
6 Month Concessionary Silver Membership - £17.50 p/m
Plus a Pro Rata payment, payable on first visit. (Unlimited Gym only Membership Anytime) (This membership is for those that fall into the following categories only; Students with valid NUS Card or equivalent, Corporate members; slimming world & Oasis Dentistry (verification needed) or Affiliated HCLF Club members of Squash, Tennis, Football or Bowls (Verification needed).
6 Month Over 60s Concessionary Membership - £17.50
Plus a Pro Rata payment, payable on first visit.
6 Month Junior Gold Membership - £11.50 p/m
Plus a Pro Rata payment, payable on first visit. (Unlimited Gym Only) (excluding the free weights area) before 5pm unless accompanied by an adult.)

Your chosen agreement is between yourself and the above mentioned Company, Debit Finance Collections plc is purely the collecting agent working on behalf of the above mentioned Company.

Personal Details
Title *
First Name *
Last Name *
Date of Birth *

Address & Contact Details
Company Name
(if applicable)
House Name/Number *
Postcode *
Telephone *
Mobile Phone *
(if not available please repeat first telephone number here)
E-mail *
Confirm E-mail *
  We may wish to send you marketing information from time to time, please check here if you agree.


Please read all questions carefully and answer honestly and provide any further information as necessary


  1. Has your doctor ever said that you have had a heart condition?Yes   No
  2. More Info:
  3. Have you ever had chest pains when you were doing activity?Yes   No
  4. More Info:
  5. Have you ever had chest pains when you were resting?Yes   No
  6. More Info:
  7. Have you ever been told by a medical professional that your blood pressure was too high?Yes   No
  8. More Info:
  9. Do you suffer from any bone or joint problems?Yes   No
  10. More Info:
  11. In the past year have you had any major illness or major surgery?Yes   No
  12. More Info:
  13. Have you ever been diagnosed with Diabetes?Yes   No
  14. More Info:
  15. Have you ever been diagnosed with Epilepsy?Yes   No
  16. More Info:
  17. Have you ever been diagnosed with a Respiratory Condition?Yes   No
  18. More Info:
  19. Are you currently taking any medication?Yes   No
  20. More Info:
  21. Are you pregnant?Yes   No
  22. More Info:
  23. Have you recently had a baby? (Within the last 6 weeks)Yes   No
  24. More Info:
  25. Do you ever... Lose your balance because of dizziness or lose consciousness?Yes   No
  26. More Info:
  27. Do you have any other medical conditions not mentioned?Yes   No
  28. More Info:
  29. Are you recently recovering from infection or virus? Or are you feeling unwell at present?Yes   No
  30. More Info:

I confirm that the information I have provided is true, to the best of my knowledge.

Bank Details
Account Holders Name *
Bank Account Number *
Bank Sort Code * - -
Please confirm you are the account holder and you are the only person required to authorise direct debits from this account. However if you're not the account holder please do not tick the box and click Next and you will be given the option to print a Paper DDI. *

Customer Name
Date of Birth 01/01/1970
Mobile Phone
Promo Code
Unique Reference No
Bank Account Name
Bank Account Number
Bank Sort Code --
Chosen Plan
Minimum Term Month (Non Cancellable in this period)

First Direct Debit on 01/01/1970
First Full Payment £0.00
First Direct Debit Total £0.00

The name that will appear on your bank statement will be Debit Finance Collections plc

Collecting Agent: Debit Finance Collections Plc, PO Box 6046, Milton Keynes MK1 9BA Telephone:

E-mail: [email protected] (All enquiries concerning payments should be made to this address)

Company Registration No. 3422873

Direct Debit Instruction

Debit Finance Collections plc
16 Davy Avenue, Knowlhill,
Milton Keynes, MK5 8PL

Direct Debit
Instruction to your
Bank or Building Society
to pay by Direct Debit
Name(s) of Account Holders(s)
Bank/Building Society account number
Branch Sort Code
Name and full address of your Bank or Building Society
To The Manager       Bank/Building Society

Service User Number
Instruction to your Bank or Building Society
Please pay Debit Finance Collections plc Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Debit Finance Collections plc and, if so, details will be passed electronically to my Bank/Building Society.


Banks and Building Societies may not accept Direct Debit Instructions for some types of account

Direct Debit

The Direct Debit Guarantee

  • This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.

  • If there are any changes to the amount, date or frequency of your Direct Debit, Debit Finance Collections plc will notify you 5 working days in advance of your account being debited or as otherwise agreed. If you request Debit Finance Collections plc to collect a payment, confirmation of the amount and date will be given to you at the time of the request.

  • If an error is made in the payment of your Direct Debit, by Debit Finance Collections plc or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society.

    - If you receive a refund you are not entitled to, you must pay it back when Debit Finance Collections plc asks you to.

  • You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Please Print Off and retain for your records.

Please read the Terms and Conditions

I have read the terms and conditions above and agree to them. *

Please click Next only once, it may take up to one minute for confirmation of your Payment to appear.