ATTITUDE FITNESS ENROLMENT
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FULL NAME *
DATE OF BIRTH *
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CONTACT NUMBER
EMAIL *
MEDICAL QUESTIONNAIRE
PLEASE COMPLETE ALL SECTIONS BELOW
Have you ever suffered with epilepsy? (Flashing lights are used in classes) *
Required
Are you pregnant? *
Required
Have you suffered from heart trouble? *
Required
Are you currently taking any form of medication? *
Required
If yes please explain if needed to know
Do you suffer from chest pain? *
Required
Do you ever have dizziness or feel faint? *
Required
Have you ever had high blood pressure? and/ or high cholesterol? *
Required
Have you ever had asthma, chronic bronchitis or any other chest ailments? *
Required
Do you suffer from severe back pains or any other orthopaedic problems? *
Required
Do you suffer from migraines? *
Required
Are you recovering from injury, illness or an operation? *
Required
If yes please explain if needed to know
Have you any medical condition that we should be made aware of? *
Required
If yes please explain if needed to know
Have you any history of heart disease in your immediate family (before age 55)? *
Required
PLEASE NOTE:
If you have answered YES to any of the above questions, you are advised to seek medical advice/ approval before taking part in this class.
I have been informed that if I answer YES to any of the questions above I should seek medical advice / approval before commencing this class. If i wish to continue without such advice. I do so entirely at my own risk. I confirm that I have read, fully understood and answered honestly.
I understand the nature of fitness with Attitude Fitness and confirm that I am in proper physical and mental condition to participate. If at any time I have any questions, feel unsafe or unwell I will immediately inform the instructor (or assistant) and discontinue further participation in the class.
I understand that neither the instruction or Attitude Fitness can be held responsible for any injuries or ill health of any kind arising from participation within this class or Attitude Fitness building.
ABOVE STATEMENT *
DATA PROTECTION CHANGES
Due to changes in data protection regulations (GDPR) which come into effect on 25th May 2018. We must ask our students and parents to review their marketing preferences to ensure they don't miss out on future marketing communications. PLEASE NOTE: students aged 13 and above are required to enter details and sign in accordance with GDPR.

PLEASE enter your current details below for each method of communications you agree to us using:
EMAIL: *
TEXT *
TELEPHONE *
SOCIAL MEDIA *
** COVID-19 DISCLAIMER **
1. I take full responsibility of all risks during Covid19 at Attitude Fitness. *
Required
2. I certify that I am physically fit and have not been advised to not participate in any form of exercise by a qualified medical professional. In certify that there are no health related reasons or problems which preclude active participation in a fitness workout or related activity. *
Required
3. I certify that I do not have, or have had any symptoms of Covid19 nor been around any person with or symptoms of it. *
Required
4. I will not hold Attitude Fitness or instructors responsible for any unlikely injury/ illness caused from the classes. *
Required
5. I understand the rules and regulations of government guidelines during the classes provided and that Attitude Fitness has your health and safety first and I won't put others at risk. *
Required
6. I am not being forced to take part in Attitude Fitness classes, this is my own personal decision. *
Required
I CERTIFY THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND THE CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
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THANK YOU AND WELCOME TO ATTITUDE FITNESS
DAVID, DANI, SARAH & THE TEAM
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