Health & fitness form
Confidential
Date *
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Name *
Your answer
Address *
Your answer
Phone number *
Your answer
Date of birth *
MM
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DD
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Emergency contact name *
Your answer
Emergency contact phone number *
Your answer
Emergency contact relationship to you *
Your answer
Doctors name *
Your answer
Doctors phone number *
Your answer
Medical details. Have you suffered from any of the following.
Are you on any medication?
Please list medication
Your answer
Any additional information *
Your answer
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. *
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