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Contact information - PARQ
Please complete this form before starting any class with Newport Boxercise. ALL your information will be kept strictly confidential and not shared with any third party.
Name *
Your answer
Email address *
Your answer
Address *
Your answer
Postcode *
Your answer
Phone number *
Your answer
Date of birth *
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How often do you currently exercise/week? *
Your answer
What exercises do you do? *
Your answer
How did you hear about Newport Boxercise? *
If you have/had any of the following conditions, please tick...
Please name any medications you take regularly for conditions or pain
Your answer
If you ticked any of the above conditions or have any other conditions not mentioned above, please give full details here including whether a GP or other health professional has said you are fit to exercise in this way.
Your answer
The name of your emergency contact. *
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Emergency number of your contact *
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PLEASE TICK BELOW - By ticking in the below box, you agree to Newport Boxercise terms & conditions supplied to you with your booking information and have read and understood the class recommendations. You also agree to Newport Boxercise storing and using your personal details. Your details will not be shared with any other company or institution. *
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