Registration Form
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Emergency Contact Name
*
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you booked with us before
*
Yes
No
Have you had any recent health changes
*
Yes
No
Health & PAR-Q
Please answer the following questions honestly to help us ensure your safety during group training. If you answer YES to any question, please provide details in the follow-up field.
Back/spinal pain
*
Yes
No
Headaches or migraines?
*
Yes
No
Have you recently had surgery?
*
Yes
No
Currently being prescribed medication?
*
Yes
No
Recently finished a course of medication?
*
Yes
No
Have diabetes?
*
Yes
No
Asthma or breathing problems?
*
Yes
No
Is there any other reason that you believe may prevent you from taking part in regular physical activity?
Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?
*
Yes
No
Do you feel chest pain when you do physical activity?
*
Yes
No
In the past month, have you had chest pain when not doing physical activity?
*
Yes
No
Do you lose 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
Are you currently taking medication for blood pressure or heart condition?
*
Yes
No
If yes, please specify weeks anti/post natal
Are you currently pregnant or have you recently given birth?
*
Yes
No
If you answered YES to any of the above, please provide details (medical conditions, medications, restrictions, emergency instructions).
I have answered all questions in this form honestly, and I am aware that if I have answered yes to any of the questions, I will need to consult my GP before commencing any exercise program if I am affected by any of the questions mentioned in this form or at a later date. I agree to inform my personal trainer instructor on any changes in health or fitness.
Tuesday, HIIT in the City
*
Cookie Consent
We use cookies and similar technologies to make this form work properly, improve your experience, and understand how the form is used. By continuing to use this form, you consent to the use of cookies as described in our Cookie Policy. You can manage cookies through your browser settings, but disabling certain cookies may affect how the form functions.
Cookie Policy
We use cookies and similar technologies to make this form work properly, improve your experience, and understand how the form is used. Some cookies are essential for basic functionality, while others help us analyze performance and improve our services.
By continuing to use this form, you consent to the use of cookies as described in our Cookie Policy. You can manage cookies through your browser settings, but disabling certain cookies may affect how the form functions.
If you have any questions about our use of cookies, please contact us through the appropriate support channel.
Submit
Should be Empty: