Outdoor Group Fitness Sign Up Form

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SIGN UP FORM - OUTDOOR GROUP FITNESS
PERSONAL DETAILS
Name
Age
DOB
Phone
Mobile
Address
Email
Emergency Contact No.
Name/Relation to Contact
HOW DID YOU FIND US
Internet Search
Magazine
Poster
Walking passed
Flyer
Facebook
The Beast
Referral (Name)
Other:
SELECT YOUR START DATE, PREFERED PACKAGE (*) AND PRIMARIY LOCATION
(please circle one)
Start Date
_____ / _____ / _____
Membership Package (*)
- Unlimited training at all
1 Month - $227/month
3 Month - $192/month
6 Month - $172/month
locations
+ Running T-Shirt or Singlet
Primary Location
Bondi Beach
Coogee
CBD Domain
PRE EXERCISE SCREENING QUESTIONNAIRE
Have you had or do you have any current medical conditions? (Please Circle)
Diabetes
Epilepsy
Breathing Difficulties/Asthma
Muscular Pain/Cramps
High Cholesterol
Mental Illness
A Hernia/Back Pain
Pregnant
High Blood Pressure
Pain/Tightness in the Chest
Rheumatic Fever
Male, age >45yrs
Heart/Stroke Condition
Liver/Kidney Condition
Arthritis
Female, age >45yrs
Do you smoke cigarettes? Y/N
If yes, how many per day?
Do you have a close relative who has had a stroke, heart attack or cardiovascular disease? Y/N
If yes, what’s the relation and at which age did this happen?
Are you currently on any medication? Y/N
If yes, which medication?
Is there anything not listed above that you feel is relevant to mention or that may limit your training? Y/N
Have you been hospitalised recently? Y/N
If yes, what was the reason?
( * ) Please choose your preferred package if you know which one you would like. If you’re not sure, you can choose an option
during your trial, which you can always change later.
 
 
Team One Fitness 
ABN 56 924 318 903 
.au 
M: 0424 245 578 
 

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