Fitness Assessment Form
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MEMBERSHIP Application & FITNESS ASSESSMENT FORM
Next of Kin
Have you ever suffered any of the following?
Dizziness/Fainting/ Vertigo during exercise
Low or high blood pressure
Are you pregnant or have you been pregnant in the last 3 months?
Have you had any surgery in the last 12 months?
If yes, please specify
If you answered YES to any of the above questions, you will be required to be medically cleared by your General Practitioner prior to participating in a fitness regime.
I declare that that the above information is true and correct and I undertake the training sessions of (Kickboxing – Muay Thai/Fitness/Personal Training) with qualified instructors through (Fitness of New South Wales) Tim Drury & Danielle Drury, registration number 00001455 or nominated instructor.
I agree that if I injure myself I have done so at my own risk, and I do not hold the above persons liable or responsible for any damages or payment. I also acknowledge that I am training at my own risk and I will not hold FITE108 Muay Thai Pty or any of their instructors liable for any injuries I may sustain.
I am participating in this Kickboxing/Fitness session by my own accord and understand the risk’s associated. I have informed the instructors of any past illnesses, injuries and have been cleared by my Medical Practitioner before commencing any training.
I hereby declare that I agree to the above conditions
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