Lorna Scott Fitness

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Lorna Scott Fitness

Screening Form

Have you ever suffered from any of the following?

Heart Disease

High Blood Pressure

Other cardio problems

Headaches/Fainting/Dizziness

Restricted movement in any joint

Back Pain

Neck Pain

Knee Pain

Other joint pain?

Are you pregnant?

Have you had a baby in the last 3 months?

Any medical condition that may interfere with exercise?

Complete newcomer to exercise?

Other:

I would prefer to receive communications from Lorna Scott Fitness in the following ways: *

By Email

By Being Part of a WhatsApp group

By Telephone

Required

Full Name: *

Email Address: *

Contact Telephone Number: *

Home Address *

Date of Birth (Format as: dd/mm/yyyy): *

I confirm that to the best of my knowledge, the information above is correct & that I enter into this programme fully aware of the ‘at risk’ groups. *

By ticking this box I confirm that the above statement is correct

Required

I confirm that I have read and agree to the Lorna Scott Fitness Terms and Conditions (available at www.lornascott.co.uk). *

By ticking this box I confirm that the above statement is correct

Required

Data protection and consent form

The data protection act requires us to use any information we hold about our members responsibly and within the definitions of the act. One of the ways in which the act affects us is that in theory we are not allowed to identify you to other members without your specific permission. We have therefore taken the decision to ask all our members to consent to us using the information we hold about you at our discretion specifically and solely for the purposes of our business.This may include (but is not limited to) such things as mentioning members’ names and achievements in classes, including members’ names and successes in our weekly and other email newsletters. Using the health information you have provided to help us offer the very best service to you.

Whilst we take all reasonable steps, we cannot reasonably guarantee the confidentiality of any information contained within emails, text messages or other electronic communication. Lorna Scott Fitness will not pass directly any information we hold on you to any third party organisations without express and specific consent.

None of the above affects or alters your statutory rights, and you may within the terms of the act request to see and seek to amend any information we hold on you at any time.
We continue to be bound by the provisions of the act in terms of the way in which we process and store any and all personal information. You remain protected in law against any abuses by us, intentional or otherwise of the terms of the act. We continue to ensure best practice in our business dealings and in everything we do in the interests of our members.

I consent to Lorna Scott Fitness using the information it holds about me at their discretion for the specific and sole purpose of the efficient and effective running of Lorna Scott Fitness. *

By ticking this box I confirm that the above statement is correct

Required

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