2021 ANU Sport Registration Form- New participant

Registration and Medical History- New participant
Name of event*
Event details:
Full Name*

First NameLast Name
ANU ID#
Postgraduate or Undergraduate*

PostgraduateUndergraduateOther
Date of birth*
DD/MM/YYYY
What is your Gender?*
Email*
example@example.com
How did you hear about this event?*

Social MediaWebsiteWord of MouthANU Sport Fitness CentreOther
COVID-19
ANU Sport is taking a highly precautionary approach to manage the spread of COVID-19, which is in line with the latest national and local health advice. We ask each participant to confirm the following before attending our group fitness classes:*

That you have not travelled overseas within the last 14 days;That you are not showing signs and symptoms of COVID-19 (fever; flu like symptoms such as coughing, sore throat or headaches; or have difficulty breathing);That you have not had close contact with a person who has been confirmed with COVID-19; andThat you will follow ANU Sport's directions in regards to hygiene while participating in class, including sanitizing your hands and wiping down equipment.
HEALTH PRE-SCREENING
Stage 1: To identify individuals with known disease, and/or signs or symptoms of disease, whom may be at a higher risk of an adverse event due to exercise. Please complete the questions below. Should you have any questions about the screening form please contact an exercise professional for clarification.
Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?*

YesNo
Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?*

YesNo
Do you ever feel faint, dizzy or lose balance during physical activity/exercise?*

YesNo
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*

YesNo
If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?*

YesNo
Do you have any other conditions that may require special consideration for you to exercise?*

YesNo
I believe that to the best of my knowledge, all of the information I have supplied within this document is correct.

IMAGE RELEASE TERMS

By signing below, I give consent to participate in the taking of photos, video and interviews by the ANU Sport and Recreation Association Inc.

This includes the right for the ANU Sport and their associates to edit and use said products for non-profit purposes including print, on the internet (including Social Media) and in any other forms of media. I also hereby release the ANU Sport and Recreation Association Inc. and its agents and employees from all claims, demands and liabilities whatsoever in connection to the above.

Please sign below:
Signature*
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Registration and Medical History- New participant