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Staff Benefits

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Staff Benefits and Wellbeing

Application Form -Scarborough Hospital Onsite Gym

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First five digits on the back of your Trust ID badge*

Please Chose one of the following*

If you are a Student, please add your contract end date below


Personal Details

Full Name*

Email Address*

Assignment Number *


Mobile Number*

Would you like to be added to a Whats App Group to receive Gym updates?*

I require access to*

Additional Members (you can pay for up to 4 additional members but if they do not have an ID badge they can only use the gym with you. Additional members must be 16 years old or over.)

Additional Member No.1

Name & Date of Birth

Requires access to

First five digits on ID badge (if applicable)

Additional Member No.2

Name & Date of Birth

Requires access to

First five digits on ID badge (if applicable)

Additional Member No.3

Name & Date of Birth

Requires access to

First five digits on ID badge (if applicable)

Additional Member No.4

Name & Date of Birth

Requires access to

First five digits on ID badge (if applicable)

Payroll Deduction (only complete if you are paying through your salary)

By checking this box, I authorise York and Scarborough Teaching Hospital NHS Foundation Trust to deduct the following amount from my salary each month from the next available salary.

Total deduction


I confirm I have read and are in agreement with the below declaration.

Email 2*:

* required fields

Please read the following before submitting the above form:

• I understand that this is an unmanned gym.
• I agree to abide by the rules and regulations of the gym and squash court (full details available on the Staff Benefits website)
• I understand it is my responsibility to ensure any additional members adhere to the rules and regulations and the points raised in this declaration.
• I understand that it is my responsibility to maintain my own safety at all times whilst using the facility
• I understand that it is my responsibility to seek advice from my GP before undertaking any form of exercise
• I agree to accept fully the responsibility for any loss/injury/death caused by the result of using the equipment.
• I understand that I do not have to undertake an induction and that I can contact my own Instructor/Personal Trainer to arrange this if needed.
• I understand that any abuse of the facility will result in my membership being revoked
• I understand that any additional members I sign up will only be able to use the gym with me unless they hold a valid Trust badge of their own.
• I understand that if I cancel my membership all additional memberships will be cancelled
• All information on this form is protected by the new GDPR rules.
• Members under the age of 18 must be accompanied by an adult paying member when using the gym.

Standing Orders

If you have completed a membership application form and have been instructed by the Staff Benefits Team to set up a Standing Order, click here for our bank details

Click here to return to the 'Scarborough Hospital Onsite Gym' page

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