Membership Form

Student Code of Conduct PDF

Fill in the Physical Activity Readiness Questionnaire form below.

If under 18 to be completed by a parent/guardian.

First name*

Last name*

Email*

Phone*

Birthday*

Day

Month

Year

Address*

House No, Street/Road, Postcode.

Gender*

Male

Female

Prefer not to say

Do you have any medical conditions we need to know about?*

Do you have any learning difficulty, special educational or disability needs?*

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?*

Yes

Do you feel any pain in your chest when you do physical activity?*

Yes

In the past month, have you had a chest pain when you were not doing physical activity?*

Yes

Do you lose balance because of dizziness or do you ever lose consciousness?*

Yes

Do you have a bone or joint problem (for example back, kneed or hip) that could be made worse by a change in your physical activity?*

Yes

Is your doctor currently prescribing medication for your blood pressure or heart condition?*

Yes

Do you know of any other reason why you should not take place in physical activity?*

Yes

If 'YES' please comment.*

I agree to the Members Code of Conduct.

I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.

If you have answered 'YES' to one or more questions you should consult with your doctor prior to joining our classes. Otherwise please sign here to confirm that you have read, understood and accurately completed this questionnaire. SIGN BELOW:*

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