• Junior Pre Exercise Questionnaire

  • Date of Birth*
     - -

  • Health Information:

  • 1. Does your child have any existing medical conditions?*
  • 2. Is your child currently taking any medications?*
  • 3. Has your child had any injuries in the past year?*
  • 4. Does your child have any allergies?*
  • 5. Is your child required to be cleared by a doctor for physical activity or sports?*
  • Browse Files
    Cancelof

  • If not available, a staff member will be in touch to discuss further. Please continue to complete and submit form.

  • Fitness and Activity Information:

  • 1. How would you describe your child's current level of physical activity?*
  • 2. What types of physical activities does your child enjoy? (Tick all that apply)*

  • 3. Does your child experience any difficulty with physical activities?*
  • 4. Has your child ever experienced any of the following during exercise?*

  • Emergency Contact Information:

    Please ensure is different to the Parent/Guardian above
  • Do you give permission for you child's photo to be taken and used for promotional purposes?*

  • Read Terms & Conditions

  • Your personal information is collected by the City of Melville LeisureFit for the purpose of administering your request and providing relevant updates about LeisureFit programs and services. Your information may be shared with authorised City staff and trusted systems we use to manage bookings and communications. You can request access to or correction of your information at any time. If you choose not to provide this information, we may be unable to process your request.

    Read our Privacy Policy and find further information about your privacy rights and personal information.

  • Should be Empty: