Has your doctor ever said that you have a heart condition and you should only do physical activity recommended by a doctor?

Yes

No

Do you have high blood pressure?

Yes

No

Do you have any pain in your chest when you do physical activity?

Yes

No

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

No

Do you have bone or joint problem that could be made worse by a change in your physical activity?

Yes

No

Are you currently taking any prescribed medication excluding the contraceptive?

Yes

No

Do you know of any reason why you should not be undertaking physical activity?

Yes

No

Declaration. I have read, understood and completed the above questionnaire and acknowledge that there are risks and dangers inherent in physical exercise and duly undertake the activity at my own risk. Any liability on the part of the operators is excluded unless negligence can be proven. I agree to observe the rules and conditions of membership. I also acknowledge that I must not use any piece of equipment for which I have not been shown how to use by an instructor. I confirm that the information which I have provided is correct at this time and should I become aware of any relevant changes to my health or condition, I will inform an instructor.

Please complete the following questions

Set your password

Are you sure?