Registration Form - Frame Running Cup 2025

2nd Emergency Contact

First NameLast Name

Emergency Number

Please enter a valid phone number.

Has your Doctor ever told you that you have a heart condition or have you ever suffered a stroke?*

YESNO

Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?*

YESNO

Do you ever feel faint or have spells of dizziness during activity/exercise that causes you loss of balance?*

YESNO

Have you had an Asthma attack required immediate medical attention at any time over the last 12 months?*

YESNO

Do you suffer from Asthma? If so, please bring your inhaler with you (if required)*

YESNO

If you have Diabetes (Type 1 or 2) have you had trouble controlling your blood glucose in the last 3 months?*

YESNO

Do you have diagnosed muscle, bone or joint problems that you been advised that could be made worse by participating in physical activity/exercise?*

YESNO

Have you been advised by a Medical Professional that you have high blood pressure, high cholesterol or high blood sugar levels?*

YESNO

Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*

YESNO

If Yes, what are the medical condition(s)

Have you spent any time in Hospital (including day admission for any medical condition, illness or injury) in the last 12 months?*

YESNO

Are you currently taking a prescribed medication(s) for any medical condition(s)?*

YESNO

If Yes, what are prescribed medication(s)

Are you pregnant or have you given birth within the last 12 months?*

YESNO

Do you suffer from any allergies that could cause anaphylactic reactions?*

YESNO

If Yes, what are your allergies?

Please type name of the person signing this document

Full name or Athlete, Parent/Guardian or Authorised Representative

I, certify and acknowledge; That I understand the potential risks involved in participating in any physical exercises or activities within the S6HP I'MPossible Program and assume the responsibility and risks. I understand that participating in an exercise program may include, but not limited to, serious bodily injury, heart attack, paralysis, stroke or even death. I consent voluntarily to participate in the I'MPossible Program, S6HP Remote Program delivered by S6HP I'MPossible Pty Ltd.

That S6HP I'MPossible and any Coach of I'MPossible have advised me prior to the commencement of participation in the I'MPossible Program that participation could result in physical injury.

That I freely and knowingly assume the risk in all Programs delivered by S6HP I'MPossible Pty Ltd, and hereby waive any right, claim or cause of action against S6HP I'MPossible Pty Ltd and release them from any liability for any injury, cost, damage or expense, loss of personal property or claim whatsoever arising, which I or anyone on my behalf might incur as a direct result or indirect result of participation in the S6HP I'MPossible Program/s.

You acknowledge and consent to photographs and electronic images being taken of you during I'MPossible Program/s. You acknowledge and agree the such photographs or electronic images are owned by I'MPossible Pty Ltd and that they may be used on Social Media Platforms such as Facebook, Instagram, LinkedIn and websites for promotional or other purposes without your further consent.

That I have read the above and understand and agree with each of the foregoing points

Signature*

Date

How did you hear about us?*

Frame Running Cup Registration Form

Athlete Details

Emergency Contact

Health/Medical Details