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07980 311 438

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Sign-up Form & Pre-Exercise Questionnaire for Gym In The Park and Personal Training.

This questionnaire has been designed to ensure that you begin your activity with Gym in the Park and Personal Training quickly and safely. We value your privacy and do not share your information with third-parties. If you would like to know more, please read our Privacy Policy

Name *
Address *
Date of Birth *
Date of Birth
Do you have a heart condition and/or have you been recommended for medically supervised activity? *
Do you have chest pain brought on by physical activity? *
Do you suffer from dizziness or fainting? *
Do you have a joint problem that could be aggravated by physical activity? *
Are you a diabetic? *
Has a doctor ever recommended medication for your blood pressure or a heart condition? *
Do you suffer from breathlessness after slight exertion? *
Are you over 65 and unaccustomed to regular physical exercise? *
If you have answered yes to any of the above questions, please contact your GP following your workout to get written consent that you are in suitable physical condition to undergo regular exercise.
Do you have a family history of heart disease in parents or siblings below the age of 65? *
Are you currently pregnant or have you had a baby in the last six months? *
Is there any other reason why you should not partake in regular physical activity? *
Do you have high/raised blood pressure (hypertension)? *
Do you suffer from Epilepsy? *
Do you exercise regularly? *
I recognise, and agree, that the instructor is not able to provide me with medical advice with regard to my medical fitness and that the above information is used only as a guideline to the limitations of my ability to exercise. I understand, and agree, that I partake in this exercise at my own risk. *
I agree that any photographic or film material in which my image is shown can be used for promotional purposes by Gym in the Park *