FITLIFE Mangere  
FITLIFE Mangere is a free Community Health and Fitness Initiative, held 6am - 7am every Tues, Thurs and Saturday Morning.

This round will run for 8 weeks starting Tuesday 7th of January - Saturday 29th of February 2020

Venue: Mangere Recreation Center, 14 Waddon Pl, Mangere Town Center.

Registrations close Thursday 2nd of January 2020 or when maximum numbers are reached.

First Preference will be for those that are
1) Registering for their first FITLIFE Challenge
2) Those that have completed 70% or more of the previous FITLIFE Challenge.
All others will be on a waiting list and confirmed on Thursday 2nd of January 2020

Feel free to forward this link onto your family and friends

Please ensure all contact details are correct and current as we will use the contact details you enter as the main form of contact when we send your confirmation email.


Please note that all your information is kept confidential within the FITLIFE database only and will not be used for any other marketing purposes. Please provide accurate and up to date contact details as your information will be used for your emergency purposes and for FITLIFE to keep you updated with the programme
Sign in to Google to save your progress. Learn more
HOME 4 THE DOME DONATION for the cost of a cup of coffee a week you can help build the home for the dome. If you would like information to how you can help us continue to change the health of our communities please tick the box below *
Captionless Image
Required
Full name *
Address *
 Home phone
Mobile *
Email *
Gender *
Age Group *
Required
Date of Birth *
MM
/
DD
/
YYYY
Ethnicity *
Required
If Maori, which Iwi do you belong to
Emergency contact name *
Home phone *
Details of emergency contact
Mobile phone *
Details of emergency contact
Current physical activity *
How many times do you exercise?
Required
Curent physical condition *
Required
List the type of activity you are currently doing
What are the main goals you want to acheive from the FITLIFE programme? *
Required
Why are these goals important to you? *
Do you have a family history of any of the following?
How long ago was your last visit to your Doctor or Health Clinic?
Have you had or do you have any of the following conditions? *
Required
Have you had any major surgery or been hospitalized in the last 12 months
If yes please provide details
Is there any other condition that may affect your ability to participate? *
Do you smoke *
If Yes, have you considered giving up smoking?
Clear selection
Have you attended a FITLIFE Challenge before?
Clear selection
How did you hear about FITLIFE?
Are you registered with an ETHC Clinic? *
I understand D65 Fitness will provide me with a safe and effective fitness programme, I understand there is risk involved and I take responsibility for my own actions. D65 fitness, East Tamaki Health Care and any of its associate organisations shall not be liable or responsible for any injuries to me resulting in my participation in the FITLIFE programme *
Signature, typing your name will be sufficient
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms