Project:fit | Unlimited Plus Membership Waiver - Project:fit

For most people, physical activity should not pose any problem. This form is designed to identify the small number of people for whom physical activity might be inappropriate for or those who should seek medical advice to establish the type of activity most suitable for them.
Please try to answer the following questions as honestly as possible.

* Indicates required field

Full Name *

First

Last

Date of Birth *

Email Address *

Mobile Number *

Next of Kin *

Next of Kin's Phone Number *

Doctor's Surgery *

Before photo *

Max file size: 20MB

Weight *

Height *

Days/times free for initial consultation *

Has your doctor ever said that you have a bone or joint problems, such as arthritis that has been aggravated by exercise or might be made worse with exercise? *

Do you have high or low blood pressure? *

Do you have Diabetes Mellitus or any other metabolic disease? *

Has your doctor ever said you have raised cholesterol (serum level above 6.2mmol/L)? *

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Have you ever felt pain in your chest when you do physical exercise? *

Is your doctor currently prescribing you medication? *

Have you ever suffered from unusual shortness of breath at rest or with mild exertion? *

Is there any history of Coronary Heart Disease in your family? *

Do you often feel faint, have spells of severe dizziness or have lost consciousness? *

Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women)? *

Do you currently smoke? *

Do you exercise less than 3 times a week and/or work in a job that is not physically demanding? *

Are you, or is there any possibility that you might be pregnant? *

Do you know of any other reason why you should not participate in a physical activity programme? *

If you have answered yes to any of the above questions, please explain: *

Assumption of Risk
I hereby state that I have read, understood and answered honestly the questions above.
In consideration of being allowed to participate in the activities and programmes of Fit4Life (Essex) Ltd, I do hereby waive, release and therefore discharge Fit4Life (Essex) Ltd from any and all responsibility or liability for injuries or damage resulting from my participation in any activities or my use of equipment or facilities in fitness related activities. I understand and I am aware that strength, flexibility and aerobic exercise including the use of equipment are potentially hazardous activities. I also understand that exercise and fitness activities involve a risk of injury and even death, and that I am voluntarily participating in these activities and use of equipment and facilities with the knowledge of the dangers involved.

I hereby agree to expressly assume and accept all and any risks of injury and death. I am aware that I have the right to request advice from any of the Fit4Life (Essex) Ltd/Project:fit team at any time in relation to the activities and exercise being undertaken and, but not exclusively, their suitability for me, with particular regard to my health. If I choose not to take the advice, or to disregard any advice so given, I do so voluntarily and accept liability for all resulting injuries or damage.

I do hereby declare myself to be physically sound and suffering from no impairment, disease or infirmity or other illness that would prevent my participation or the use of equipment or facilities except as herein stated. I acknowledge that I have either had a physical examination and have been given my doctor’s permission to participate, or that I have decided to participate in activity and use of equipment and machinery without the approval of my doctor and do hereby assume all responsibility for my participation and activities and utilisation of equipment and machinery in my activities.

One month’s cancellation notice is required of monthly memberships.

Photos and videos may be taken during any session for promotional purposes. I will inform a Fit4Life (Essex) Ltd/Project:fit representative if I would rather not be in a photo.

Please tick *

Accept risk I have liked the Project:fit Facebook page I would like to receive special offers and promotions via e-mail from Project:fit

All data collected by Fit4Life (Essex) Ltd is held securely and will never be passed on to any other party. The data held will be used by Fit4Life (Essex) Ltd/Project:fit to contact you if there are any changes to the services you use and any other important announcements, as well as occasional special offers.

Send

This form must be completed when
signing up to our Unlimited Plus membership

hello@projectfit.uk
07872916917

This form must be completed when​signing up to our Unlimited Plus membership

hello@projectfit.uk07872916917​

This form must be completed when
signing up to our Unlimited Plus membership

hello@projectfit.uk
07872916917