Junior Personal Training

1

Parent/Guardian Details

First Name

Last Name

2

Relationship to Participant

3

Phone Number

Please enter a valid phone number.

4

Email

example@example.com

5

Participant Details

First Name

Last Name

6

Date of Birth

Date

7

Age

8

Does your child have any medical conditions?

YESNO

9

Has your child ever had any surgery?

YESNO

10

Does your child currently have any injuries or physical limitations that may affect exercise?

YESNO

11

Is your child currently taking any medication?

YESNO

12

Does your child have asthma?

YESNO

13

Does your child have any allergies?

YESNO

14

Has your child ever experienced chest pain, dizziness, fainting or shortness of breath during exercise?

YESNO

15

Has a doctor or healthcare professional ever advised your child not to participate in exercise?

YESNO

16

Is there anything else you would like me to know about your child's health or wellbeing?

YESNO

17

If you answered Yes to any question, please provide further details in the space provided.

18

Parental ConsentI confirm that I am the parent/legal guardian of the participant named above. I give permission for my child to participate in personal training sessions conducted by Sonia Gargaglione at Anytime Fitness Crows Nest. I confirm that the information provided in this form is accurate and complete to the best of my knowledge. I agree to inform Sonia Gargaglione of any changes to my child's medical condition, injuries or medications that may affect their participation in exercise. I understand that participation in exercise involves inherent risks. While all reasonable care will be taken to provide a safe training environment, I acknowledge these risks and give permission for my child to participate. I understand that my child may receive general, evidence based and age appropriate nutrition guidance as part of their coaching program.