Women’s Fitness Bootcamp Registration & Consent
A registration, health questionnaire and consent form for a women’s fitness bootcamp. Your information is confidential and used to keep you safe.
Personal Details
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Email Address
*
example@example.com
Mobile Number
*
Emergency Contact Name
*
Emergency Contact Telephone Number
*
Health Questionnaire (PAR-Q)
Has a doctor or healthcare professional ever told you that you have a heart condition?
*
Yes
No
Do you experience chest pain during physical activity?
*
Yes
No
Have you experienced chest pain whilst at rest during the last month?
*
Yes
No
Do you suffer from dizziness, fainting or loss of balance?
*
Yes
No
Do you have any bone, joint or muscular problems that could be affected by exercise?
*
Yes
No
Do you take medication for blood pressure or a heart condition?
*
Yes
No
Are you currently pregnant or have you given birth recently?
*
Yes
No
Have you had surgery within the last 12 months?
*
Yes
No
Do you have asthma or any respiratory condition?
*
Yes
No
Do you have epilepsy?
*
Yes
No
Do you have diabetes?
*
Yes
No
Do you have any medical condition that could affect your ability to exercise safely?
*
Yes
No
Do you have any allergies?
*
Yes
No
Are you currently receiving medical treatment?
*
Yes
No
Do you have any injuries or physical limitations?
*
Yes
No
Please provide details of any medical conditions, injuries, medications or anything else I should know before you take part.
*
Fitness Goals
What are your fitness goals?
*
Improve fitness
Build strength
Lose body fat
Improve confidence
Improve mental wellbeing
Increase energy
Return to exercise after having children
Meet like-minded women
General health
Other
Bringing a Child
Will you be bringing a child with you?
*
Yes
No
Child's Name
Child's Age
Will your child be:
*
Watching only
Participating (where appropriate)
I understand that I remain fully responsible for the supervision, behaviour and safety of my child throughout the session. I understand that bringing my child is entirely at my discretion and that I must ensure they are able to remain safe within the training environment.
I confirm that I have read and agree to the above statement regarding bringing my child.
*
I confirm that I have read and agree to the above statement regarding bringing my child.
Participant Declaration & Liability Waiver
I confirm that all information I have provided is true and accurate.
*
I confirm that all information I have provided is true and accurate.
I understand that physical exercise involves inherent risks, including the risk of injury.
*
I understand that physical exercise involves inherent risks, including the risk of injury.
I choose to participate voluntarily and accept responsibility for my own participation.
*
I choose to participate voluntarily and accept responsibility for my own participation.
I will exercise within my own abilities and will stop if I feel unwell or experience pain.
*
I will exercise within my own abilities and will stop if I feel unwell or experience pain.
I will inform my instructor if my health or medical condition changes.
*
I will inform my instructor if my health or medical condition changes.
I understand that participation may be refused if it is considered unsafe for me to take part.
*
I understand that participation may be refused if it is considered unsafe for me to take part.
Booking Terms & Conditions
I understand that missed sessions cannot be transferred to another date.
*
I understand
I understand that six-session block bookings run for six consecutive weeks from my selected start date.
*
I understand
I understand that block bookings cannot be paused, extended or shared with another person.
*
I understand
If I bring a child, I understand that I remain fully responsible for their supervision and safety at all times.
*
I understand that if I bring a child, I remain fully responsible for their supervision and safety at all times.
Digital Signature
Full Name
*
First Name
Last Name
Digital Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: