Health declaration

Please fill out the following form.

First name

Last name

Email*

Phone

Date of birth

Day

Month

Year

Emergency contact:

Are you currently taking any medication?

No

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

Do you have asthma

No

Yes

Do you have Epilepsy

No

Yes

Have you been told by a health professional you shouldn't exercise?

No

Yes

If you answered yes to any of the questions above, or if there's anything else you think I should know, please supply additional information.

Initials*

I declare that the info I’ve provided is accurate and complete.

07765585773

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