Pre Exercise Questionnaire

FULL NAME

DOB

PHONE NUMBER

Format: 0000-000-000.

EMAIL

EMERGENCY NAME & NUMBER

ADDRESS

Street Address Line 2

OCCUPATION

WHERE DID U HEAR ABOUT BOWENFIT?

Are you currently exercising?

Frequency & description of exercise

What results are you wanting to achieve?

What class day/time suits you?

MEDICAL HISTORY - Please mark 'X' Do you or have you had any of the following:

Details (if yes to any of the above)

Do you have any injuries that may effect your training?

Are you currently taking any prescribed or over the counter medication?

List medication:

Details of any special diet:

Low carb, fasting, meal plans, low calorie, etc.

How often do you consume alcohol?

I agree the above information provided is correct and I have addressed all of my medical conditions and restrictions that may lead to injury, limit or restrict my training. I understand that I take FULL responsibility for my voluntary participation in any fitness classes and activity offered by BOWENFIT. I do NOT hold BOWENFIT and or any trainer associated with BOWENFIT or the City of Stirling accountable for any injury or loss that may be caused during or after any fitness training session/s.
At times photos may be taken during class times and I may be asked if promotional photos can be added to BOWENFIT website, Facebook or Instagram pages for advertising purposes only.

DATE

SIGNATURE