Blitzfit Chermside Health Form Questionnaire 2020

STEP 1: COMPLETE THE HEALTH FORM 2026
Let's start with your name!

First NameLast Name
Your Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your mobile number
Your email address

Confirmation Emailexample@example.com
Your birthday (day/month/year)
Your occupation & company you work for (if applicable)
Is your job physical or sedentary?
What do you think your current fitness level is?
Are you currently exercising at the moment?
If you are currently exercising, what sort of exercise are you doing and how often each week do you do this?
YOUR GOALS! What do you want to achieve by training with us at boot camp (select all relevant answers):

Other
When do you want to hit these goals by?

How important is it to you that you reach your goals?

	1	2	3	4	5

1 is Not important at all, 5 is Very important

What is your main reason or motivation for wanting to achieve these goals?
Can you think of any obstacles or challenges that will stop you, or has stopped you in the past from reaching your goals?
Are you interested in joining our team at Blitzfit after your 7 day trial?
Would you like some information about our personal training packages too?
Who of your friends/family are supporting you in your training program?
Do you have a friend who you think would like to join you at training?

HEALTH ASSESSMENT - Do you suffer from, or have you ever suffered from any of the following:

Rows	Yes	No
Arthritis
Asthma
Diabetes
Epilepsy
Heart Condition
High or low blood pressure
Heart palpitations/chest pain
Any infections or infectious diseases
Back pain
Any major injuries
Females: Have you been pregnant recently

If you answered "Yes" to any of the HEALTH ASSESSMENT questions above, please explain condition(s).
Do you have any current injuries, niggles or acute pain that might affect your training?
If you answered "YES" to any of the HEALTH ASSESSMENT questions above, please advise whether you are cleared by your Doctor to exercise. Please note, if your GP or health professional has advised you NOT to exercise, for your own safety you will not be able to participate in our boot camps until you can provide a medical clearance from your GP.

Do you:

Rows	Yes	No
Smoke
Drink alcohol
Eat 'junk' food

If yes, how much and how often?
YOUR EMERGENCY CONTACT'S NAME:

First NameLast Name
YOUR EMERGENCY CONTACT'S RELATIONSHIP TO YOU:
YOUR EMERGENCY CONTACT'S PHONE NUMBER:
DECLARATION

By ticking the YES box below, I warrant to Katherine Gorrie that all information provided on this form is true and correct. I accept that I will not have any claim or any nature against Katherine Gorrie and/or any trainers contracted under her business for any illness, injury or adverse change in medical condition or state of health arising directly or indirectly from any program or advice provided by or carried out preparatory to or as part of any program I undertake whilst under the supervision or instruction of Katherine Gorrie and/or any trainers contracted under her business. Any rights granted to me by law which are not capable of change by agreement remain unaffected by the terms of this agreement.
By selecting YES, I agree to the above.
Please sign:
STEP 2: SELECT YOUR START DATE!
Which date would you like to start your first session?
PLEASE NOTE: Your 7 day trial will begin on the date you select above and will end 7 consecutive days after this date. You will have unlimited access to all our training sessions on the timetable during this time. Your first trial session must be booked within 7 days of your trial purchase. No refunds can be offered for change of mind nor no-shows so please choose carefully.

This offer is only valid for those who have not already had a trial with us (Blitzfit Australia Chermside/Aspley, previously Boot Camps Australia Chermside) and is not available for prior/existing Blitzfit boot camp members.

This is a no-obligation trial and you are under no pressure to join after your trial ends.
Please sign here to acknowledge that you have read and understood the Trial Ts & Cs above:
STEP 3: PURCHASE YOUR 7 DAY TRIAL:
prevnext( X )
7 Day Bootcamp Experience Pass$15.00 AUD
Come on down and train with our amazing bootcamp crew for one week of unlimited sessions.

Total $0.00 AUD
Payment Methods

Choose from one of the PayPal options to make your payment.
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STEP 1: COMPLETE THE HEALTH FORM 2026

DECLARATION

STEP 2: SELECT YOUR START DATE!

STEP 3: PURCHASE YOUR 7 DAY TRIAL:

*

Payment Methods