Pre-exercise questionnaire

Name *

Date of Birth *

Address *

Postcode *

Contact Number *

Emergency Contact *

Have you ever had any injury, illness, back or joint condition that could be aggravated by exercise? *

Yes

Please specify

Have either of your parents or siblings had heart problems prior to the age of 60? *

Yes

Please specify

Are you pregnant or have you recently given birth?

Are you currently taking any prescribed medication?

Is there any other condition not mentioned in the above that we need to know about?

If you have answered YES to any of the above questions, or you are not sure, please consult your doctor before partaking in any form of exercise. If NO, please answer the remaining questions.

Do you currently participate in regular exercise?

Yes

What type of exercise do you currently do?

How would you describe your current physical condition?

What do you aim to achieve from exercising?

Weight Loss

Fitness Improvement

Increase Size

Muscle Tone

Sports Specific

Good Health

Stamina

If ANY of the above information changes, please inform The Club immediately.

I declare that to the best of my knowledge, the information given is correct and I know of no reason why I should not participate in an exercise programme or class. I understand that I enter into any exercise programme entirely at my own risk. *

I accept the above fitness declaration

Date *

Consent for storing submitted data *

Yes, I give permission to store and process my data

Pre-exercise questionnaire

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