Junior Pre Exercise Questionnaire

  • 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?*
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  • 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?*
  • Should be Empty: