Registration Form - I'MPossible Fitness Program

  • I'MPossible Registration Form

  • Which Location are you interested in attending?*
  • Select a day and time*
  • Select a day and time*
  • Select a day and time*
  • Select a day and time

  • Athlete Details

  • Date of Birth*
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  • Format: 0000 000 000.

  • NDIS or Payment Details

  • Plan expiry date?
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  • NDIS Funding Support Category (if known)?*
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  • Emergency Contact

    Parent/Guardian or Advocate ReprSaveesentative
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    • 2nd Emergency contact (If relevant)  
    • Format: 0000 000 000.

  • Health/Medical Details

  • Has your Doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
  • Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?*
  • Do you ever feel faint or have spells of dizziness during activity/exercise that causes you loss of balance?*
  • Have you had an Asthma attack required immediate medical attention at any time over the last 12 months?*
  • Do you suffer from Asthma? If so, please bring your inhaler with you (if required)*
  • If you have Diabetes (Type 1 or 2) have you had trouble controlling your blood glucose in the last 3 months?*
  • Do you have diagnosed muscle, bone or joint problems that you been advised that could be made worse by participating in physical activity/exercise?*
  • Have you been advised by a Medical Professional that you have high blood pressure, high cholesterol or high blood sugar levels?*
  • Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*
  • Have you spent any time in Hospital (including day admission for any medical condition, illness or injury) in the last 12 months?*
  • Are you currently taking a prescribed medication(s) for any medical condition(s)?*
  • Are you pregnant or have you given birth within the last 12 months?*
  • Do you suffer from any allergies that could cause anaphylactic reactions?*

  • I, certify and acknowledge; That I understand the potential risks involved in participating in any physical exercises or activities within the S6HP I'MPossible Program and assume the responsibility and risks. I understand that participating in an exercise program may include, but not limited to, serious bodily injury, heart attack, paralysis, stroke or even death. I consent voluntarily to participate in the S6HP I'MPossible Program, S6HP Remote Program delivered by S6HP I'MPossible Pty Ltd.

    That the Parent or Guardian give permission for their Child named above to be able to participate in the online S6HP Remote Program, and at times communicating with the Coaches and Mentors within the online classroom.

    S6HP I'MPossible is not responsible for the training environment the remote Athlete may choose to train, although advice can/will be given what a safe training environment should be, ultimately it is the responsibility of the parent to control the remote training environment.

    That S6HP I'MPossible and any Coach of S6HP I'MPossible have advised me prior to the commencement of participation in the I'MPossible Program that participation could result in physical injury.

    That I freely and knowingly assume the risk in all Programs delivered by S6HP I'MPossible Pty Ltd, and hereby waive any right, claim or cause of action against S6HP I'MPossible Pty Ltd and release them from any liability for any injury, cost, damage or expense, loss of personal property or claim whatsoever arising, which I or anyone on my behalf might incur as a direct result or indirect result of participation in the S6HP I'MPossible Program/s.

    You acknowledge and consent to photographs and electronic images being taken of you during S6HP I'MPossible Program/s. You acknowledge and agree the such photographs or electronic images are owned by S6HP I'MPossible Pty Ltd and that they may be used on Social Media Platforms such as Facebook, Instagram, LinkedIn and websites for promotional or other purposes without your further consent.

    That I have read the above and understand and agree with each of the foregoing points

  • Date
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