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WELCOME TO GEELONG BOXING CLUB
How did you hear about Geelong Boxing Club?
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I hereby understand The Training Room Geelong is not liable for any injury / accident that occurs inside or outside the facility whilst I am training as a guest. I understand that my details will be used to include me on The Training Room Geelong mailing list and that I can choose to unsubscribe at any time. My contact details may be used to contact me by staff members of The Training Room Geelong only.
Has a doctor ever told you that you have a heart condition or have you ever had a stroke?
YES
NO
Do you ever experience unexplained pains in your chest ?
YES
NO
Do you ever feel faint or have spells of dizziness during exercise that causes you to lose balance?
YES
NO
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
YES
NO
Do you have diabetes and have you had trouble controlling your blood glucose in the last 3 months?
YES
NO
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity / exercise?
YES
NO
Have you spent time in hospital (including day admission) during the last 12 months?
YES
NO
Are you currently taking prescribed medication(s) for any medical condition(s)?
YES
NO
Are you pregnant, or have you given birth in the last 12 months?
YES
NO
IF YOU ANSWERED ‘YES’ to any of these questions, please see guidance from your GP or appropriate allied health professional prior to undertaking physical exercise. Is there anything you would like us to know about past injuries or your current physical condition?
YES
NO
I believe that to the best of my knowledge, all of the information I have supplied within this form is correct.
ALMOST DONE! PLEASE COMPLETE HEALTH SCREEN BELOW BEFORE TRAINING
Has a doctor ever told you that you have a heart condition or have you ever had a stroke?
YES
NO
Do you ever experience unexplained pains in your chest ?
YES
NO
Do you ever feel faint or have spells of dizziness during exercise that causes you to lose balance?
YES
NO
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
YES
NO
Do you have diabetes and have you had trouble controlling your blood glucose in the last 3 months?
YES
NO
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity / exercise?
YES
NO
Have you spent time in hospital (including day admission) during the last 12 months?
YES
NO
Are you currently taking prescribed medication(s) for any medical condition(s)?
YES
NO
Are you pregnant, or have you given birth in the last 12 months?
YES
NO
IF YOU ANSWERED ‘YES’ to any of these questions, please see guidance from your GP or appropriate allied health professional prior to undertaking physical exercise. Is there anything you would like us to know about past injuries or your current physical condition?
YES
NO
I believe that to the best of my knowledge, all of the information I have supplied within this form is correct.
I have had the terms and conditions of Membership and Stripe Direct Billing explained clearly to me. I understand the terms and conditions of membership and cancelation procedures.
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