F45 Training Bulleen - Pre-exercise Screening Form

F45 Training Bulleen - Pre-exercise Screening Form

Please take a few minutes to answer the following questions
Full Name*

First NameLast Name
Phone Number*
Email Address*
example@example.com
What is your Instagram account name so we can tag you?
Age*
Gender*

FemaleMale
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
MEDICAL CONSIDERATIONS:

It is our professional duty of care to ask all participants, no matter what age, to complete the following questions.
Has a family member (under 60), suffered from heart disease, stroke, raised cholesterol or sudden death?*

YesNo
Are you a male over 35 or female over 45 and NOT used to vigorous exercise?*

YesNo
Are you on any prescribed medication?*

YesNo
Have you been in hospital recently?*

YesNo
Are you pregnant?*

YesNo
Have you given birth in the last 6 weeks?*

YesNo
Do you have any infections or infectious diseases?*

YesNo
Do you have, or have you had:
- Gout
- Glandular Fever
- Any Heart Condition
- Muscular Pain
- Stroke
- Rheumatic Fever
- Heart Murmur
- Cramps
- Diabetes
- Dizziness or Fainting
- High Blood Pressure (over 140/90)
- Raised Cholesterol/Triglycerides
- Epilepsy
- Stomach/Duodenal Ulcer
- Hernia
- Liver or Kidney Condition
- Palpitations or Pains in the Chest
- Asthma
- Arthritis
YesNo
If YES, which one?
Do you have any pain or major injuries in the following areas:
If you have ticked any of the above, you need a signed medical clearance from your doctor before starting exercise.

Or,
I warrant that I am physically and mentally well enough to proceed with F45 TRAINING sessions.
Client's self-clearance of the above conditions:
Signature

Clear
LIFESTYLE AND CURRENT EXERCISE HABITS
Are you currently exercising?*

YesNo
If yes, what type of exercise and how many times per week?
Do you smoke?*

YesNo
If yes, how many per day? If no, have you quit recently?
Are you allergic to anything?*

YesNo
If yes, please specify
What are your health and fitness goals?*

Reduced body fatImproved aerobic capacityGain muscle definitionImprove fitness levelGain strengthImprove athletic performanceJoin a like minded communityOther
If other, please specify
ACCEPTANCE
By signing this document, I acknowledge that engaging in physical activity may carry some risks to my health. I release F45 Training Bulleen, its directors, agents, personal trainers, staff and sub-contractors for any liability for loss of injury, which I may suffer whilst participating in any activities however otherwise caused. I have been advised that it is in my best interest to complete a physical examination by a registered medical practitioner to confirm that I am fit and able to engage in strenuous and prolonged activities. I agree to disclose any physical limitations, disabilities, ailments or impairments which may affect my ability to participate in fitness programs hereon. I agree to allow F45 Training to use pictures, videos or the like for potential marketing material. I also understand that all activities in any fitness program are optional and I may stop at any time.
I confirm to the best of my knowledge all details provided are accurate and that I have read, understood and agree to the Declaration of Indemnity Waiver.*

Clear
PARENT/GUARDIAN ACCEPTANCE - UNDER 18 YEARS OF AGE

I, being the parent or guardian of the person named in this acknowledgement and release, HEREBY ACKNOWLEDGE AND AGREE: I have read the whole document and understand it. I consent to the person named in this document, participating in the activity and I am aware of the risks, dangers and obligations set out in this release form. IN CONSIDERATION of the person named in this document and in them being accepted to participate in the activity I AGREE TO RELEASE AND INDEMNIFY F45 TRAINING, in the same manner and to the same effect as if I were the person first named in this release, and the person participating in the activity.
PARENT/GUARDIAN ACCEPTANCE - UNDER 18 YEARS OF AGE

Clear
Type a question
Should be Empty:

F45 Training Bulleen - Pre-exercise Screening Form

MEDICAL CONSIDERATIONS:

LIFESTYLE AND CURRENT EXERCISE HABITS

ACCEPTANCE