• Family Fitness Screening Form

  • We want to provide the best class possible for you and your family and to do that we must make sure everyone is safe. Therefore, if there are any outstanding injuries or medical issues that may impact anyones ability to exercise it is really important we know before the session.

    So if you could please provide details for everyone coming below and detailing any questions ticked "yes." in the bottom box. Thank you! We will never share any of your information and will remove any information when it is no longer needed.

     

  • Adult 1

  • Do you have a heart condition or have you ever been told by a doctor that you should only do physical activity recommended by a doctor?*
  • Do you feel pain in your chest when you do physical activity?*
  • In the past month, have you had chest pain when you were not doing physical activity?*
  • Do you lose your balance because of dizziness or do you ever lose consciousness?*
  • Do you have any bone or joint problem that could be made worse by a change in your physical activity?*
  • Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
  • Do you know of any other reason why you should not do physical activity?*

  • Adult 2 (only complete if two adults are coming)

  • Do you have a heart condition or have you ever been told by a doctor that you should only do physical activity recommended by a doctor?
  • Do you feel pain in your chest when you do physical activity?
  • In the past month, have you had chest pain when you were not doing physical activity?
  • Do you lose your balance because of dizziness or do you ever lose consciousness?
  • Do you have any bone or joint problem that could be made worse by a change in your physical activity?
  • Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
  • Do you know of any other reason why you should not do physical activity?

  • Child 1

  • Does your child have a heart condition or have they ever been told by a doctor that they should only do physical activity recommended by a doctor?*
  • Does your child feel pain in their chest when they do physical activity?*
  • In the past month, has your child had chest pain when they were not doing physical activity?*
  • Does your child lose your balance because of dizziness or do you ever lose consciousness?*
  • Does your have any bone or joint problem that could be made worse by a change in their physical activity?*
  • Is your child's doctor currently prescribing drugs (for example, water pills) for their blood pressure or heart condition?*
  • Do you know of any other reason why your child should not do physical activity?*

  • Child 2 (only complete if two children are coming)

  • Does your child have a heart condition or have they ever been told by a doctor that they should only do physical activity recommended by a doctor?
  • Does your child feel pain in their chest when they do physical activity?
  • In the past month, has your child had chest pain when they were not doing physical activity?
  • Does your child lose your balance because of dizziness or do you ever lose consciousness?
  • Does your have any bone or joint problem that could be made worse by a change in their physical activity?
  • Is your child's doctor currently prescribing drugs (for example, water pills) for their blood pressure or heart condition?
  • Do you know of any other reason why your child should not do physical activity?

  • Child 3 (only complete if three children are coming)

  • Does your child have a heart condition or have they ever been told by a doctor that they should only do physical activity recommended by a doctor?
  • Does your child feel pain in their chest when they do physical activity?
  • In the past month, has your child had chest pain when they were not doing physical activity?
  • Does your child lose your balance because of dizziness or do you ever lose consciousness?
  • Does your have any bone or joint problem that could be made worse by a change in their physical activity?
  • Is your child's doctor currently prescribing drugs (for example, water pills) for their blood pressure or heart condition?
  • Do you know of any other reason why your child should not do physical activity?
  • Should be Empty: