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WELCOME TO GEELONG BOXING CLUB
Has a doctor ever told you that you have a heart condition or have you ever had a stroke?
YES
NO
I hereby understand Geelong Boxing Club is not liable for any injury / accident that occurs inside or outside the facility whilst I am training as a guest.
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 consent to having photos taken during sessions, which may be used for promotional purposes online (e.g., website, social media). I understand that I can withdraw this consent at any time
I believe that to the best of my knowledge, all of the information I have supplied within this form is correct.
CONFIRM
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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