Medical Hold Form

Medical Hold Form

Membership Medical Hold form

Name

First Last

Phone

Email(Required)

Reason for placing membership on Hold(Required)

Date to start hold of membership must be a Friday*(Required)

Date to recommence membership (max of 3 months from start of hold membership) must be a Friday*(Required)

Upload Medical Certificate(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB, Max. files: 2.

Select your Location

Artarmon

Sydenham

Thornleigh

Date(Required)

Note if you are under the age of 18 years of age, please obtain permission from your parent/guardian by having them co-sign the certificate below.

Parent or Guardian Name

First Last

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