GRL Health and Fitness
Personal Activity Readiness Questionnaire and Induction Form
Name
First Name
Last Name
What is your mobile number?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Next of kin full name
Next of kin contact number in event of emergency
Are you taking any medication currently? If yes please list which medication and for what condition
Have you any injuries, illnesses or conditions which could be made worse by exercise?
Has a doctor ever advised you not to participate in exercise?
Please Select
Yes
No
If yes, please provide some information and confirm if you have been told you can participate in exercise since this occasion
Do you have or have history with any of the following?
Epilepsy
Type 1 Diabetes
Type 2 Diabetes
Eating Disorder
Heart Condition
Other
None of the above
If you selected any of the above, please provide some detail
Do you lose your balance because of dizziness or do you ever lose consciousness?
Please Select
Yes
No
Do you have a bone or joint problem that could be made worse by change in your physical activity?
Please Select
Yes
No
Are you currently taking any fat-loss or appetite-suppressing injections (e.g. Mounjaro, Wegovy, Ozempic) or any other GLP-1 medications?
Yes
No
Do you know of any other reason you should not do physical activity?
We may feature members in photos and videos for gym promotions. Please indicate your preference below
Yes, I consent to being featured.
No, I do not consent to being featured.
We may feature members’ names in the public areas of the gym such as loyalty walls and client log files. Please indicate your preference below
Yes, I consent
No, I do not consent
By signing below you also understand that GRL and its members of staff cannot be made liable for any new or existing injuries or illnesses whilst part of GRL Health and Fitness or its coaching services including Semi Private and 100 Day Slay online coaching.
By signing below you are in agreement to tidy away any equipment used and leave the gym as you found it.
Please note due to the expense of the wall mirrors within the GRL Health and Fitness building, if you cause damage you must pay for their replacements. By signing below you are in agreement with this policy which is applicable for all GRL Health and Fitness members, Semi Private clients and 100 Day Slay clients.
By signing this document you have watched the induction video and understand to ask any questions if not sure about anything within the gym.
Signature
Submit
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