Jazzy B Fitness Health Questionnaire for Online Clients

Jazzy B Fitness Health Questionnaire
Congratulations on obtaining your FREE trial to a Jazzy B Fitness Class! To secure your place, please complete the following Health Questionnaire.
Your Details
Name*

First NameLast Name
Date of Birth

DayMonthYear
Email*
example@example.com
Phone Number*
How did you hear about us?*
Name of person who recommended*

Your FREE Trial
Our classes take place in the comfort of your own home every Monday and Wednesday from 7-8pm.

You will receive the link to join the online fitness class at 6:45pm.
Choose a date to come along for your FREE trial*

DayMonthYear

Your Health
Emergency Contact Name*
Emergency Phone Number*
Are you under the age of 16?*
Are you pregnant?*
Are you currently taking any medication?*
Has the doctor ever told you that you suffer from:

High Blood PressureHeart DiseaseDiabetesEpilepsyBreathing problems (eg Asthma)Bone or Joint problems (eg Arthritis)Back Issues
Are you currently suffering from any injuries or illnesses?*
Please use this space to provide more detail or tell us about anything else you feel we should be aware of:

Health Questionnaire Declaration
I would like to take part voluntarily in fitness classes in order to attempt to improve my physical fitness.

I understand that the cardiovascular activities are designed to place an increasing workload on the heart and lungs and to thereby attempt to improve their efficiency. Toning exercises will exert muscles which should improve muscular endurance and flexibility exercises should improve/maintain range of motion.

I understand that I am responsible for monitoring myself throughout the class and, should any unusual symptoms occur, I would cease participation and inform the instructor of the symptoms.

In signing this consent form, I confirm that I have read this form and that I understand the nature of the exercise programme. I also confirm that my questions regarding the exercise programme have been answered to my satisfaction.

In the event of any injuries occurring as a result of attendance, Jazzy B Fitness staff / owner is hereby released from any liability now, or in the future, for conditions that may be obtained from participation.
I have read and agree with the Health Questionnaire Declaration
At Jazzy B Fitness, we occasionally take photos and videos of classes and training sessions. These photos and videos are mainly used in the Jazzy B Fitness private Facebook groups to motivate, encourage and inspire clients.

However they may occasionally be used as marketing and promotional material for the Jazzy B Fitness Facebook page, website and marketing leaflets and emails.

You can learn more about how we process personal data in accordance with the General Data Protection Regulations in our Privacy Notice available at www.jazzybfitness.co.uk
I am happy for any photos/videos to be used
Todays Date*

DayMonthYear
Should be Empty:

Jazzy B Fitness Health Questionnaire

Your Details

Your FREE Trial

Your Health

Health Questionnaire Declaration