Health Check Form | jstfitness

First name

Last name

Email

Phone

Birthday

Day

Month

Year

Address

Emergency Contact & Number

Do you currently have or have you ever had:

If you selected any of the above, please provide details

Are you currently taking any medication that could affect your ability to exercise?

Do you have any injuries or pain at the moment?

Is there anything else we should know about your health?

Are you currently pregnant?

Yes

No

Current activity level:

Beginner

Intermediate

Advanced

Types of exercise currently doing

How many times per week do you exercise?

I consent to photos/videos being used for promotional purposes

Yes

No

I confirm that I am physically fit to participate in exercise. If I have any doubts, I will consult a medical professional before taking part. I understand it is my responsibility to inform the trainer of any health changes.

I have read and agree to the Liability Waiver & Informed Consent.

Signed

Date

Day

Month

Year