2getfit Wahanda Bookings

Medical Questionnaire & Booking Form - Wahanda
Name
E-mail
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mobile Tel No
Telephone Number

Area CodePhone Number
Name of Next of Kin
Next of Kin Tel No
Medical Questionnaire - If You Answer Yes to Any of the Questions Below- book an appointment with Your GP before Attending or Confirm to us he or she has told You its ok to attend!
Do You have Bone/Joint Problem
Do you have High Blood Pressure
Do You have Diabetes?
Do You have Asthma?
Do you have heart or lung Problems?
Is there a history of heart disease in the family?
Do You ever sufffer Pains in your chest?
Have you recently had an operation ?
Are you taking any prescribed medicines?
Taking Part in Our Program involves/Risk of injury/Death. Do you acknowledge that you take part at your own risk?
If you answered yes to any medical problems you need to see your Dr before your 1st session with us and seek clearance
If my current health Changes you must let us know immediately
Taking Part in Our Program involves the risk of injury - do you acknowledge that you take part at your own risk ?
All Packages are subject to our standard terms and conditions
How did you purchase your bootcamp place?
PLEASE ENTER YOUR VOUCHER NUMBER HERE
Date you want to start - be careful we cannot accept amendments once bookings are made

MonthDayYear
Names of Friend or family your attedning with, if your attending alone, simply type n/a
Please Book Your Sessions from Below - You need to book one session per week over 4 consecutive Weeks.
Please chose your preferred day to train each week
Please enter the date of the 1st nsession you would like to attend

MonthDayYear
Should be Empty:

Medical Questionnaire & Booking Form - Wahanda

Medical Questionnaire - If You Answer Yes to Any of the Questions Below- book an appointment with Your GP before Attending or Confirm to us he or she has told You its ok to attend!

Please Book Your Sessions from Below - You need to book one session per week over 4 consecutive Weeks.