Congratulations!

You're one step closer to realising a fitter, healthier and happier YOU!

Before you can start Bootcamp we need to know all about you......in so far as what injuries, if any, you have or if you suffer from any health concerns.

The information you provide to us in completing the Health Questionnaire will be used only by the Instructor to ensure that your physical and health needs are accommodated for in all sessions.

Name *
Name
D.O.B *
D.O.B
To participate in Bootcamp you must be 15yrs and over
Phone *
Phone
Eg 040 912 3456 (instead of 0409 123 456)
Let us know how you heard about/found us
Health Questionnaire
Describe your current physical condition *
Are you currently involved in any exercise/sports activities? *
What is the main benefit you are wanting from exercise? *
Have you ever had any injury, illness, back or joint pain or condition that may be affected by exercise? *
Have you ever had/do you have Arthritis, Asthma, Diabetes, Epilepsy, Hernia or Dizziness? *
Have you ever had Gout, Circulation problems or an Ulcer? *
Have you ever had High Blood Pressure, Rheumatic Fever, Stroke or High Cholesterol? *
Have you ever had/do you have a Heart condition, palpitations, murmurs or pains in the chest? *
Have any of your immediate family members had any heart problems prior to age 60? *
Are you now, or have you recently been, pregnant? *
Are you taking any prescribed medication? *
Is there any other condition that might be reason to modify your exercise program?
Has a Doctor ever advised you not to undertake certain exercise activities? *
Is there any other information that the Instructor needs to know regarding your health? *