Healthy Ageing

Personal Information
Full Name*

First NameLast Name
Gender

FemaleMaleOther
Date of Birth*

DayMonthYear
Phone
Email
Occupation
Do you participate in any physical activities outside of work? If so, name them here, this can be running, yoga, weightlifting etc
What is your goal in regard to your health and fitness?.*
Emergency contact detail
Full Name*

First NameLast Name
Relationship
Phone
Medical
Have you been diagnosed (currently or in the past) with any significant medical condition and/or suffered an injury?*

YesNo
If yes, what are they?
What additional treatment(s) are you receiving for the given health problem(s)/ injury?
Session Type
Monthly membership
Block sessions
Type of session you are interested in?
please enter the number of sessions/service you are after?
Refer a friend to get 15% off your sessions!!

Please note that this is optional
If so, enter the person's name and phone number.
please enter the person's name and phone number here.
Photography

Photographs might be taken at the workshops. We will make sure these photographs are taken in a way that your face isn't shown and that they are respectful images. These images will be used by Strength Based to share news about the workshop, and to publicise our future sessions and events. Images may be used in press releases, printed publicity and published on Strength Based's website. They will be stored securely, and we will delete them after they are no longer needed for publicity purposes. If you preferred that you're not to be photographed, please speak to Tim on (07436057074). If you would like to see your images, or would like us to delete them, please email the group on timfj.pt@gmail.com

You do not have to have your photograph taken, and you can always ask to not be in them or opt out at any point😊

Privacy Policy
Would you be happy for us to take photographs during the workshop/group session?

YesNo
How did you find out about the workshop?
Can we contact you to tell you about future workshops, weightlifting sessions, events and newsletters?*

YesNo
Should be Empty:

Refer a friend to get 15% off your sessions!!