Fitsquad Sign Up Form

All information supplied on this form will be kept strictly confidential and never shared with a third party.

Name:

Which location do you want to join:

When do you want to start:

Membership Type:

Gender:
MaleFemale

Address:

Date of Birth:

Mobile Number:

Home Number:

Emergency Contact Name:

Emergency Contact Number:

Doctors Name:

Doctors Number:

Email Address: (personal)

Email Address: (work)

We only ask employer details as if we find that a lot of people are joining from the same
company or location and train on way home from work, we will consider this
when deciding on class times and venue.

How Did You Hear About FitSquad?:

If Referred by a current or previous member please name:

Have you had any form of illness/disease eg asthma, diabetes, epilepsy?

Is there a history of heart disease in your family?

Do you suffer from chest pains?

Do you suffer from high blood pressure?

Do you suffer from high cholesterol levels?

Are you currently taking any medication?

Have you had surgery in the last 4 months?

Are you or have you been pregnant in the last 4 months?

Have you any muscle or joint injuries?

Have you had any condition that may be aggravated by weight lifting?

Have you any condition that may limit your exercise programme?

Have you ever been advised not to exercise by a doctor?

Do you smoke?

If yes how many a day?

Do you exercise?

If yes, what type and how often?

If you have answered yes to more than one of the above questions please consult
with your doctor on this before participating in this FitSquad activity.

Click here to confirm that you agree to the terms, conditions and waiver

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