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1. PERSONAL DETAILS
2. HEALTH & WELLBEING
3. YOUR FITNESS GOALS
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PERSONAL DETAILS
First Name
Last Name
Email
Phone
Postcode
Gender
*
Male
Female
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EMERGENCY CONTACT
Emergency Contact Name
Emergency Contact Phone
HEALTH & WELLBEING
Have you ever had any of the following illnesses/injuries? (Please tick the boxes that apply)
Heart Attack
Stroke
Epilepsy
Diabetes
Cancer
Asthma
Allergies
Arthritis
Viral Infections
High Blood Pressure
Low Blood Pressure
Other
If you ticked any of the above, please explain further.
Do you take any medications or supplements?
*
Yes
No
Please list them and explain how they affect you.
Is there anything else that may affect your training?
YOUR FITNESS GOALS
What is your main purpose of training?
*
What are your top 3 fitness goals?
*
What type of training are you interested in?
Cardio Endurance
Interval Training
Olympic Weight Lifting
Strength & Conditioning
Boxing & Kick-boxing
Yoga & Pilates
Other
If you ticked other, please list here.
Is there anything that you can't do?
*
Yes
No
Any other concerns?
