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Membership Application
Home
The Club
About Us
Our Heritage
Learn To Swim
Mum & Baby
Guppies
Goldfish
Turtles
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Dolphins
Sports
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Membership Application
*
Membership type
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Single
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FILL MEMBER DETAILS
Member details 1
MEMBER DETAILS
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First name
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For any reason, have you been hospitalised in the last 6 months?
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Do you lose your balance due to dizziness or do you lose consciousness while exercising?
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Do you suffer from bone or joint problems that could be aggravated by exercise
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Do you smoke? If yes, how many?
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HEALTH CONDITION
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Do you suffer or have ever suffered from any of the following?
Diabetes
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Neurological Conditions
Respiratory Conditions
None of the above
Others
*
If others, kindly specify
*
TERMS OF USE
I confirm that the information I have provided is accurate.
I understand that false information may lead to my membership being terminated without notice.
I give my consent for the information in this form to be processed in order to facilitate access to, use of, purchase of, or participation in our service and product offerings, including memberships; events, meetings or conference; educational programmes; online forums; and marketing.
I am aware that I may choose to terminate my membership at any point in time and withdraw my consent for data holding.
I confirm that I have read and understood the Sirens Sports Facilities Membership Terms and Conditions.
FILL MEMBER 2 DETAILS
Member details
MEMBER 2 DETAILS
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First name
*
Last name
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Member Phone Number
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Emergency Phone Number
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Member's DOB
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1935
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1933
1932
1931
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
(Must be 3 years or above)
*
Gender
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Male
Female
Non-binary
*
Your email
*
ID Card
(max file size 1 GB)
PHYSICAL DETAILS
*
Do you have a family history of any conditions or diseases?
-Select-
Yes
No
*
Please specify
*
Are you used to regular exercise?
-Select-
Yes
No
*
Please specify
*
For any reason, have you been hospitalised in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Do you lose your balance due to dizziness or do you lose consciousness while exercising?
-Select-
Yes
No
*
Please specify
*
Do you suffer from bone or joint problems that could be aggravated by exercise
-Select-
Yes
No
*
Please specify
*
Do you suffer from chest pain during physical activity?
-Select-
Yes
No
*
Please specify
*
Are you on medication or have been on medication in the last six months?
-Select-
Yes
No
*
Please specify
*
Are you (or may be) pregnant now or have given birth in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Are you aware of any condition that should prevent you from exercise?
-Select-
Yes
No
*
Please specify
*
Do you smoke? If yes, how many?
-Select-
Yes
No
*
Please specify
*
Are you on any medication or any dietary supplements?
-Select-
Yes
No
*
Please specify
HEALTH CONDITION
*
Do you suffer or have ever suffered from any of the following?
Diabetes
High/Low Cholesterol
High/Low Blood Pressure
Liver/Kidney Conditions
Heart/Circulatory Conditions
Musculoskeletal Conditions
Neurological Conditions
Respiratory Conditions
None of the above
Others
*
If others, kindly specify
*
TERMS OF USE
I confirm that the information I have provided is accurate.
I understand that false information may lead to my membership being terminated without notice.
I give my consent for the information in this form to be processed in order to facilitate access to, use of, purchase of, or participation in our service and product offerings, including memberships; events, meetings or conference; educational programmes; online forums; and marketing.
I am aware that I may choose to terminate my membership at any point in time and withdraw my consent for data holding.
I confirm that I have read and understood the Sirens Sports Facilities Membership Terms and Conditions.
FILL MEMBER 3 DETAILS
Member details
MEMBER 3 DETAILS
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First name
*
Last name
*
Member Phone Number
*
Emergency Phone Number
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Member's DOB
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2
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1992
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1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
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1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
(Must be 3 years or above)
*
Gender
-Select-
Male
Female
Non-binary
*
Your email
*
ID Card
(max file size 1 GB)
PHYSICAL DETAILS
*
Do you have a family history of any conditions or diseases?
-Select-
Yes
No
*
Please specify
*
Are you used to regular exercise?
-Select-
Yes
No
*
Please specify
*
For any reason, have you been hospitalised in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Do you lose your balance due to dizziness or do you lose consciousness while exercising?
-Select-
Yes
No
*
Please specify
*
Do you suffer from bone or joint problems that could be aggravated by exercise
-Select-
Yes
No
*
Please specify
*
Do you suffer from chest pain during physical activity?
-Select-
Yes
No
*
Please specify
*
Are you on medication or have been on medication in the last six months?
-Select-
Yes
No
*
Please specify
*
Are you (or may be) pregnant now or have given birth in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Are you aware of any condition that should prevent you from exercise?
-Select-
Yes
No
*
Please specify
*
Do you smoke? If yes, how many?
-Select-
Yes
No
*
Please specify
*
Are you on any medication or any dietary supplements?
-Select-
Yes
No
*
Please specify
HEALTH CONDITION
*
Do you suffer or have ever suffered from any of the following?
Diabetes
High/Low Cholesterol
High/Low Blood Pressure
Liver/Kidney Conditions
Heart/Circulatory Conditions
Musculoskeletal Conditions
Neurological Conditions
Respiratory Conditions
None of the above
Others
*
If others, kindly specify
*
TERMS OF USE
I confirm that the information I have provided is accurate.
I understand that false information may lead to my membership being terminated without notice.
I give my consent for the information in this form to be processed in order to facilitate access to, use of, purchase of, or participation in our service and product offerings, including memberships; events, meetings or conference; educational programmes; online forums; and marketing.
I am aware that I may choose to terminate my membership at any point in time and withdraw my consent for data holding.
I confirm that I have read and understood the Sirens Sports Facilities Membership Terms and Conditions.
FILL MEMBER 4 DETAILS
Member details
MEMBER 4 DETAILS
*
First name
*
Last name
*
Member Phone Number
*
Emergency Phone Number
*
Member's DOB
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1
2
3
4
5
6
7
8
9
10
11
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13
14
15
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18
19
20
21
22
23
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Month
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1986
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1983
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1981
1980
1979
1978
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1972
1971
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1968
1967
1966
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1960
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1953
1952
1951
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1941
1940
1939
1938
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
(Must be 3 years or above)
*
Gender
-Select-
Male
Female
Non-binary
*
Your email
*
ID Card
(max file size 1 GB)
PHYSICAL DETAILS
*
Do you have a family history of any conditions or diseases?
-Select-
Yes
No
*
Please specify
*
Are you used to regular exercise?
-Select-
Yes
No
*
Please specify
*
For any reason, have you been hospitalised in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Do you lose your balance due to dizziness or do you lose consciousness while exercising?
-Select-
Yes
No
*
Please specify
*
Do you suffer from bone or joint problems that could be aggravated by exercise
-Select-
Yes
No
*
Please specify
*
Do you suffer from chest pain during physical activity?
-Select-
Yes
No
*
Please specify
*
Are you on medication or have been on medication in the last six months?
-Select-
Yes
No
*
Please specify
*
Are you (or may be) pregnant now or have given birth in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Are you aware of any condition that should prevent you from exercise?
-Select-
Yes
No
*
Please specify
*
Do you smoke? If yes, how many?
-Select-
Yes
No
*
Please specify
*
Are you on any medication or any dietary supplements?
-Select-
Yes
No
*
Please specify
HEALTH CONDITION
*
Do you suffer or have ever suffered from any of the following?
Diabetes
High/Low Cholesterol
High/Low Blood Pressure
Liver/Kidney Conditions
Heart/Circulatory Conditions
Musculoskeletal Conditions
Neurological Conditions
Respiratory Conditions
None of the above
Others
*
If others, kindly specify
*
TERMS OF USE
I confirm that the information I have provided is accurate.
I understand that false information may lead to my membership being terminated without notice.
I give my consent for the information in this form to be processed in order to facilitate access to, use of, purchase of, or participation in our service and product offerings, including memberships; events, meetings or conference; educational programmes; online forums; and marketing.
I am aware that I may choose to terminate my membership at any point in time and withdraw my consent for data holding.
I confirm that I have read and understood the Sirens Sports Facilities Membership Terms and Conditions.
FILL MEMBER 4 DETAILS
Member details
MEMBER 5 DETAILS
*
First name
*
Last name
*
Member Phone Number
*
Emergency Phone Number
*
Member's DOB
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2020
2019
2018
2017
2016
2015
2014
2013
2012
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2009
2008
2007
2006
2005
2004
2003
2002
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2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
(Must be 3 years or above)
*
Gender
-Select-
Male
Female
Non-binary
*
Your email
*
ID Card
(max file size 1 GB)
PHYSICAL DETAILS
*
Do you have a family history of any conditions or diseases?
-Select-
Yes
No
*
Please specify
*
Are you used to regular exercise?
-Select-
Yes
No
*
Please specify
*
For any reason, have you been hospitalised in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Do you lose your balance due to dizziness or do you lose consciousness while exercising?
-Select-
Yes
No
*
Please specify
*
Do you suffer from bone or joint problems that could be aggravated by exercise
-Select-
Yes
No
*
Please specify
*
Do you suffer from chest pain during physical activity?
-Select-
Yes
No
*
Please specify
*
Are you on medication or have been on medication in the last six months?
-Select-
Yes
No
*
Please specify
*
Are you (or may be) pregnant now or have given birth in the last 6 months?
-Select-
Yes
No
*
Please specify
*
Are you aware of any condition that should prevent you from exercise?
-Select-
Yes
No
*
Please specify
*
Do you smoke? If yes, how many?
-Select-
Yes
No
*
Please specify
*
Are you on any medication or any dietary supplements?
-Select-
Yes
No
*
Please specify
HEALTH CONDITION
*
Do you suffer or have ever suffered from any of the following?
Diabetes
High/Low Cholesterol
High/Low Blood Pressure
Liver/Kidney Conditions
Heart/Circulatory Conditions
Musculoskeletal Conditions
Neurological Conditions
Respiratory Conditions
None of the above
Others
*
If others, kindly specify
*
TERMS OF USE
I confirm that the information I have provided is accurate.
I understand that false information may lead to my membership being terminated without notice.
I give my consent for the information in this form to be processed in order to facilitate access to, use of, purchase of, or participation in our service and product offerings, including memberships; events, meetings or conference; educational programmes; online forums; and marketing.
I am aware that I may choose to terminate my membership at any point in time and withdraw my consent for data holding.
I confirm that I have read and understood the Sirens Sports Facilities Membership Terms and Conditions.
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