Strength through Menopause

Name*

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Contact Number*
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Address

Street Address

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Email*
example@example.com
Date of Birth*

MonthDayYear
Ethnicity
Gender Identity

FemaleMalePrefer not to sayOther
Emergency Contact Name*

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Emergency Contact Phone Number*
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Relationship to you
Do you currently have any medical conditions we should be aware of before participating in a strength-based exercise programme? (Yes/No)

YesNo
If yes, please provide brief details.
Are you currently experiencing any menopause-related symptoms that may impact exercise?

YesNo
If yes, please provide more detail
Have you been advised by a GP or health professional to avoid any specific exercises?

YesNo
If yes, please provide further details
What’s your current activity level?

SedentaryLightly ActiveActiveVery Active
What are your primary goals for joining this programme?

Increase StrengthManage SymptomsBuild ConfidenceLearn techniqueImprove EnergyOther
How did you find out about us
Please Confirm*

I am over 18 years old and am fit to participate in physical activity
I understand my details will be uploaded to our systems as a memberI consent to my information being stored securely and used for programme delivery and evaluation, in line with data protection laws (GDPR).*Payment Confirmation I understand that my place is only confirmed once full payment is made in advance.
*ZEST takes your privacy very seriously and we will only use the information you've submitted to provide the services requested of us. Further details about the personal information we record and how it's used can be found in our Privacy Policy
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