Health Questionnaire - Evolve Fitness UK

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For your safety and to ensure you get the most out of your workout, it is important that I am aware of your current medical and physical status. Please complete this form as fully and honestly as possible. All information provided will remain strictly confidential. Should any of the details provided change in the future, please let us know.

We require all of the fields in this questionnaire to be completed.

Email *

Name *

Mobile Number *

Emergency Contact Name *

Emergency Contact Number *

Relationship to Emergency Contact *

Please tick if any of the following apply to you: *

I have high blood pressure, heart disease, diabetes, epilepsy, breathing problems or bone/joint problems.

I am pregnant, breast-feeding or I have given birth in the last six weeks.

I am currently suffering from an injury or illness.

I am currently recovering from an injury or illness.

I suffer with dizziness and fainting.

None of the above apply.

Required

If you ticked any of the boxes above, please provide further details below relating to your condition. *

Please list any medication(s) that you are currently taking below. *

Is there anything else that you feel I should know about that may affect your enjoyment of the class e.g. any difficulties with certain movements? *

How did you hear about Evolve Fitness classes? *

Occasionally we send out a Newsletter via email detailing any news about our business or changes to our timetable. Please tick below to receive this email. *

I give permission to receive Newsletters from Evolve Fitness UK

No thank you, I do not wish to receive Newsletters.

Required

I confirm that I am 16 years of age or over and would like to take part voluntarily in fitness classes (including Pilates and Yoga) with the aim of improving my fitness, strength and flexibility. I understand that cardiovascular activities such as Total Body Workout and PadFit are designed to place an increasing workload on the heart and lungs to help improve their efficiency. Toning exercises in classes such as Pilates and/or Yoga exert muscles to help improve muscular endurance and flexibility exercises will help to improve and maintain range of motion. I understand that I am responsible for monitoring myself throughout the class. Should any unusual symptoms occur, I should stop and let the instructor know immediately. There is always a risk of injury when we exercise. I understand the risk of my participation and I release Evolve Fitness UK, Rachel McGain-Harding (Owner/Instructor) and Dean McGain-Harding (Instructor) from any liability now, or in the future, for conditions that may be obtained from participation. By ticking the box below I confirm that I have read this form and I understand the nature of the exercise class(es) I plan to attend. I confirm that any questions that I have, have been answered to my satisfaction. *

I confirm that I have read and understood this form and give my full and informed consent for exercise participation.

Required

A copy of your responses will be emailed to the address you provided.

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