GoodFit Pre exercise and waiver

This is to be completed in preperation for physical activity. It is important to share any exercise-related medical conditions BEFORE commencing an exercise program with GoodFit. This assessment does not provide medical advice in any form and does not substitiute advice from appropriately qualified professionals.

Please complete this form BEFORE your first session. All information stays private and helps me keep you safe and reaching your goals.

Name*

First NameLast Name

Phone number*

Email*

example@example.com

Date of birth*

Date

Emergency contact name*

First NameLast Name

Phone number*

How many times a week do you currently exercise? *

What type of exercise do you currently do?

(e.g., walking, swimming, gym, none)

Do you have any current or past injuries? (e.g., back, knee, shoulder - please list)

Have you been told you have a heart condition?*

YesNo

Have you ever had a stroke?*

YesNo

Do you have any unexplained pains in your chest at rest or during physical exercise?*

YesNo

Do you have diabetes?*

YesNo

Do you have exercise-induced asthma that needs medication? If so, please bring it along, it’s your responsibility to have it with you.*

YesNo

Have you seen a doctor in the last 12 months for anything exercise related?*

YesNo

Do you smoke?*

YesNo

If you have answered YES to any of the above questions please seek a referral from your GP or health professional before commencing with physical activity.

What is your main goal with GoodFit? (e.g., build strength, boost energy levels, reduce weight gain)

How would you rate your current energy levels?

LowMediumHigh

Any other comments?

I understand that participating in GoodFit Manly’s outdoor fitness sessions involves physical activity with potential risks, including injury or discomfort. I confirm I’ve disclosed all relevant health conditions and take responsibility for my own safety, including bringing any necessary medication. I agree to follow instructions and release GoodFit Manly and Linda from liability for any injury or loss that may occur, to the fullest extent permitted by law.

I have read, understood, acknowledge and agree to the above.*

Yes

Signature*

Date*

Date

Pre-exercise assessment & waiver

Personal information

Health & Fitness

Your goals

Waiver