Here at Inspiring healthy lifestyles, we make fitness fun.


Become a leisure centre member is your passport to living a healthier, happier life.


As a member you'll enjoy state-of-the-art fitness equipment, invaluable fitness advice from our friendly team of instructors, and a huge range of exercise classes helping you hit your fitness goals.

Whatever you want from your leisure centre, we're here to help you make magic happen.

One last thing. If you've got a pre-existing medical condition that may interfere with your use of the gym, such as diabetes, epilepsy, a heart condition or physical disability, please contact your favourite leisure centre before progressing with this membership application.

Preferred Venue

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 *


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 / Stroke?Yes   No
  2. Have you ever had chest pains when you were resting / doing activity?Yes   No
  3. Are you on medication for blood pressure?Yes   No
  4. Do you suffer from any bone or joint problems, including back pain? Yes   No
  5. Have you had any major illness or major surgery?Yes   No
  6. Have you ever been diagnosed with Diabetes?Yes   No
  7. Have you ever been diagnosed with Epilepsy?Yes   No
  8. Have you ever been diagnosed with a Respiratory Condition?Yes   No
  9. Have you ever been diagnosed with, Stress/ Anxiety/ Depression? Yes   No
  10. Please explain:
  11. Are you pregnant / post natal (within last 6 weeks)Yes   No
  12. Please explain:
  13. Do you have any other medical conditions not mentioned?Yes   No
  14. Please state EDD:
  15. Are you recently recovering form infection or virus? Or are you feeling unwell at present?Yes   No

Declaration: I have read, understood and completed this questionnaire and declare to the best of my knowledge the above information is correct and that I know of no other reason why I should not participate in an exercise programme.


All personal information given will be used to provide you with the best service that we can and will not be passed on to any third parties other than Steps to Health Referral Officer if a referral note is required.

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: 01908 422007

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

Company Registration No. 3422873

Direct Debit Instruction

Debit Finance 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

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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.