Register - Fuel Fitness

Fuel Fitness Registration

Full Name

Email address

Phone number

Date of birth

Gender

Address Line 1

Address Line 2

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Emergency contact

Full name

Phone number

Legal Documents

Hannah Mclarnin - PARQ

Please answer the below medical information.

If any information on this form changes, please let a member of staff know immediately or make the appropriate amendments to this form.

Information on this form only may be shared with emergency services and/or our insures in the event of an emergency or incident on the premises.

Has your doctor ever said you have a heart condition, suffered from a heart attack, stroke or any other coronary heart diseases?

Yes

Have you ever experienced chest pain or tightness whilst exercising?

Yes

Have you ever been diagnosed with high blood pressure or similar?

Yes

Have you or do you suffer from asthma or any other respiratory problems?

Yes

Any allergies?

Any metabolic problems such as diabetes, thyroid, obesity?

Yes

Have you ever suffered from any neuromuscular, orthopaedic or arthritic problems?

Yes

Have you suffered any injuries in the past 12 weeks/are ongoing that we should be made aware of?

Any medications you are taking that may impact your training?

Are there any other medical problems or information that you feel your coach should be made aware of before undertaking any form of training?

I have read, understood & accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.