Community Circuit Registration
Please complete this short registration before attending your first Alta Method Community Circuit. It should only take a couple of minutes.
Full Name
*
First Name
Surname
Email
*
example@example.com
Mobile Number
*
Which Community Circuit session(s) would you like to attend?
*
Thursday 13th August 6am-7am
Thursday 27th August 6am-7am
Health Infomation
Is there anything about your health that we should know to help you exercise safely?
*
No
Yes
If Yes, please provide details
Has a doctor ever advised you to only exercise under medical supervision due to a heart condition?
*
Yes
No
Do you experience chest pain during physical activity?
*
Yes
No
Have you experienced chest pain while at rest during the last month?
*
Yes
No
Do you lose your balance because of dizziness or have you ever lost consciousness during exercise?
*
Yes
No
Do you have a bone, joint or muscle problem that could be made worse by exercise?
*
Yes
No
Are you currently taking medication for a heart condition or blood pressure?
*
Yes
No
Are you pregnant or have you given birth within the last six months?
*
Yes
No
Is there any other reason why you believe you should not take part in physical activity today?
*
Yes
No
If you answered YES to any question, please provide details:
Emergency Contact Name
*
Emergency Contact Details
*
Participant Declaration
Please read the declaration below before completing your registration.
Participant Declaration
*
I confirm that I have read and understood the information provided. I believe I am fit to take part, have informed the coaches of any relevant medical conditions or injuries, agree to follow the coaches’ instructions during the session, and choose to participate voluntarily. I understand that physical activity carries inherent risks and accept responsibility for my decision to take part.
Signature
Complete Registration
Complete Registration
Should be Empty: