Health & fitness form
Confidential
Date *
MM
/
DD
/
YYYY
Name *
Address *
Phone number *
Date of birth *
MM
/
DD
/
YYYY
Emergency contact name *
Emergency contact phone number *
Emergency contact relationship to you *
Doctors name *
Doctors phone number *
Medical details. Have you suffered from any of the following.
Are you on any medication?
Please list medication
Any additional information *
I have understood and answered all the questions honestly. I understand I should not participate if I feel unwell and if my health changes I should inform the instructor/sinkorswim. *
Required
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