How old are you:
Your Name:
Your Phone No:
Your email:
Are you currently exercising:
Tell me about any health issues or injuries you have. (please select any that may apply:
IMPORTANT NOTICE: It is wise to seek your doctor’s advice before beginning any health/fitness/nutrition program!
With doctors and physician support, are you able to participate in an exercise program? 



 
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REGISTRATION FORM
Which sessions are you committing to:
Not at allA couple times p/wk2-3 times p/wk3+ times p/wkMost days
High Cholesterol
High Blood Pressure
Heart or Lung Conditions
Hernia
Arthritis
Asthma or respitory proplems
Seizure Disorder
Diabetes
Back Pain
Neck Pain
Joint Issues or limitations
Recent Broken Bones
Recent Surgery
Muscular Disorders
Recent Injuries
Other:
YES. Click to agree
Pregnant or given birth recently
Any infectious Diseases
Take prescribed medication
Heart or Lung Condition
SAT 7am
TUE 6am
THU 6am
TUE 7.30pm
THU 7.45pm