LET'S GET TO KNOW YOU!




PERSONAL DETAILS

Full Name:

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Date of Birth:
/ /
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Contact Phone #:

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Email:

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Boot Camp Location:

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Emergency Contact Name and Phone Number:

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YOUR PERSONAL AGREEMENT


1. Goals & Current Exercise Habits...



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Voucher or Discount Code

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Start Date


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Other:

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2. To help us tailor an exercise program specifically & accurately to your needs, please answer the following questions:

(Please answer truthfully & accurately concerning your exercise history)

Do you or have you ever participated in any sporting programs?

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Are you a smoker?

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Do you exercise regularly?

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If yes, please give details below:

Type of exercise:

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Frequency of exercise:

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Perceived Intensity when exercising:

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Do you ever have negative feelings or have you ever had any bad experience with an exercise programme?

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If yes, please provide a brief explanation:

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Have you ever claimed work cover or compensation?

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If yes, when & what for?

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3. Lifestyle & Medical Considerations (Please tick which of the following apply)

Are you taking any prescribed medications?

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Are you currently carrying an injury?

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Have you suffered or do you suffer from back pain?

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Are you pregnant?

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Are you a non-exercising male over 35 or female over 45?

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Do you suffer from high or low blood pressure?

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If yes:

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Do you suffer from Diabetes?

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Has anyone in your family under the age of 60 suffered from Heart Disease?

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3a. Health Screening

(Please tick if you have or have had any of the following)

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Confirmation (*)

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Digital Signature (*)

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Captcha (*)
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Get in touch

Bangn Bodz
G4/109 Upton St
Southport, 4215

0411 374 833


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