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Contact Information

Title

First Name

Surname

Date of Birth

Address

Phone

What time is best to call you?

Calling time

Your Health information

Has your doctor ever said you have heart trouble?

Yes No

Have you ever had pain in your chest during your daily/physical activity?

Yes No

Do you often feel faint or have spells of dizziness?

Yes No

Has you ever been diagnosed with high blood pressure?

Yes No

Has a doctor said that you might have bone or joint problems, arthritis, that is aggravated by exercise?

Yes No

Have you been in hospital in the last 3 years?

Yes No

Are you currently taking any medication?

Yes No

Are you pre/post natal?

Yes No

Do you suffer from asthma, or breathing difficulties?

Yes No

Do you suffer from diabetes or epilepsy?

Yes No

Do you suffer from an allergy?

Yes No

Is their good reason not mentioned here why you should not take part in training sessions with

Yes No

Current Activity

Height

Weight

How frequently do you exercise prior to starting wtih me?

How intense are the workouts?

In case of emergencies during acitivites, please provide Next of Kin details.

Title

First Name

Surname

Relationship

Date fo Birth

Address

Phone

Please confirm your consent below.

1.The information I have provided is to the best of my knowledge true and accurate.

2. I have read and understand the terms and condition of Southwest Military Fitness and agree to be bound by them.

3. I understand that the activity provided by Southwest Military Fitness, by their nature involves an element of risk, which cannot be totally eliminated. Whilst every care to ensure the safety of the participant; activities involve the acceptance of risk and of responsibility of the consequences of one actions.

Do you understand and agree to the above declarations?

Liability Waiver

In consideration of being allowed to participate in the activities and programmes of the Easter Body Build Up and use the facilities and equipment owned and/or under the control of Pro Fitness Health Club, in addition to the payment of any fee or charge I do hereby waiver release and, forever discharge Pro Fitness Health Club from all responsibility or liability for injuries or damages resulting from participation in any activities or my use of equipment or facilities in the above-mentioned activities.

I understand and I am aware that strength, flexibility and aerobic exercise, including the use of relevant equipment, in the outdoors, are potentially hazardous activities. I also understand that exercise and fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities and using equipment and facilities with the knowledge of the dangers involved I here/by agree to expressly assume and accept all and risk of any injury or death.

I am aware that I have the right to request advice from any of the South West Military Fitness staff, at any time in relation to the activities and exercise being undertaken and, but not exclusively, their suitability for me, with particular regard to my health and equipment clothing. If I choose not such to take advice, or to disregard any advice so given, I do so voluntarily and accept liability for all resulting injuries or damage. I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease or infirmity or other illness (other than those declared on the attached medical questionnaire) that would prevent my participation or use of equipment or facilities except as herein stated.

I acknowledge that I have either had a physical examination and have been given my doctors permission to participate, or that I have decided to participate in activity and use equipment and machinery without the approval of my doctor and hereby assume all responsibility for my participation and activities, utilisation of equipment and machinery in my activities. In addition, South West Military Fitness cannot accept responsibility for valuables left with the instructors or vehicles. If I choose not such to take advice, or to disregard any advice so given, I do so voluntarily and accept liability for all resulting injuries or damage. I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease or infirmity or other illness (other than those declared on the attached medical questionnaire) that would prevent my participation or use of equipment or facilities except as herein stated.

Do you understand and consent to the above waiver?

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