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Kids
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Adults Beginners Course
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FAQ
Free Trial Class
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PLEASE COMPLETE PAYMENT AND FILL OUT THE MEDICAL FORM BELOW TO SECURE YOUR SPOT
Name
Date
Gender
Male
Female
Date Of Birth
1. Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke?
Yes
No
2. Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?
Yes
No
3. Do you ever feel faint, dizzy or lose balance during physical activity/exercise?
Yes
No
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
Yes
No
5. If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?
Yes
No
6. Do you have any other conditions that may require special consideration for you to exercise?
Yes
No
IF YOU ANSWERED ‘YES’ to any of the 6 questions, please seek guidance from an appropriate allied health professional or medical practitioner prior to undertaking exercise. Please upload any information from your doctor below.
I believe that to the best of my knowledge, all of the information I have supplied within this screening tool is correct.
Complete
