Please list any injuries or illnesses that may affect your fitness training.:
Has your doctor ever said you have heart trouble?
Yes
No
Have you ever had pains in your chest?
Yes
No
Do you often feel faint or spells of dizziness?
Yes
No
Do you have high blood pressure?
Yes
No
Do you suffer from bone or joint problems?
Yes
No
Have you been in hospital in the last 3 years?
Yes
No
Are you pre/post natal?
Yes
No
Do you suffer from breathing difficulties?
Yes
No
Are you epileptic?
Yes
No
Do you have any allergies?
Yes
No
Do you have any medical problems that will effect your ability to exercise?
Yes
No
If you have answered ‘Yes’ to one or more questions, please consult your doctor before increasing your physical activity and tell them which questions you answered yes to. If in any doubt, seek your doctor’s advice as to your suitability for unrestricted physical activity that progresses gradually.
How would you describe your current fitness levels?
Very Fit
Fit
Average
Unfit
None at All
Please choose one:
Tone Up
Lose Weight
Get Fitter
Informed Consent-Liability Waiver
In consideration of being allowed to participate in the activities and programmes of Think Urban Fitness and to use the facilities and equipment owned and/or under the control of Think Urban Fitness, in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge Think Urban Fitness from any and all responsibility or liability for injuries or damages resulting from my participation in any activities or my use of equipment or facilities in the above mentioned activities.
I understand and I am aware that strength, flexibility and aerobic exercise, including the use of equipment, in the outdoors, are potentially hazardous activities. I also understand that exercise and fitness activities involve a risk of injury and even death, and that I am voluntarily participating in these activities and using equipment and facilities with the knowledge of the dangers involved. I hereby agree to expressly assume and accept all and any risks of injury or death.
I am aware that I have the right to request advice from any of The Think Urban Fitness staff, at any time, in relation to the activities and exercise being undertaken and, but not exclusively, their suitability for me, with particular regard to my health and clothing. If I choose not to take advice, or to disregard any advice so given, I do so voluntarily and accept liability for all resulting injuries or damage.
I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease or infirmity or other illness (other than those declared on the attached medical questionnaire) that would prevent my participation or use of equipment or facilities except as herein stated. I acknowledge that I have either had a physical examination and have been given my doctors permission to participate, or that I have decided to participate in activity and use of equipment and machinery without the approval of my doctor and do hereby assume all responsibility for my participation and activities, and utilisation of equipment and machinery in my activities.
In addition Think Urban Fitness cannot accept responsibility for valuables left with the instructors or their vehicles.
Submit
