Nimfit Membership Application & Pre Exercise Questionaire
Please Complete all sections
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Emergency contact name and Phones number
Membership Option
Yearly Upfront $900
3 month upfront $240
Payment method
PAY ID - admin@nimbingym.com
Cash
Pre Exercise Questionaire
Please answer all of the quesitons truthfully. All information is kept confidential
Has your doctor ever said you have a heart condition and recommended only medically supervised activity?
yes
no
Do you feel pain in your chest when performing physical activity?
yes
no
In the past month, have you had chest pain when not doing physical activity?
yes
no
Do you lose your balance because of dizziness or do you ever lose consciousness?
yes
no
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
yes
no
Is your doctor currently prescribing drugs for your blood pressure or heart condition?
yes
no
Do you know of any other reason why you should not do physical activity?
yes
no
If you answered YES to any of the above, please provide details below and consult with your GP before starting any fitness program:
Member DeclarationI confirm that the above information is accurate to the best of my knowledge. I understand that I should consult a medical professional before starting any exercise program. I agree to abide by the rules and conditions of NIMFIT Gym.
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