Name: Gym Membership (12 months)
SKU: 822
Price: 170.00 EUR
Availability: InStock

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Health Declaration
Date of Birth *
I have a heart condition and should only do physical activity recommended by my doctor? * Yes No
I feel chest pain when I do physical activity. * Yes No
I have lost consciousness or balance due to dizziness. * Yes No
I have muscle joint or bone problems that worsen with physical activity. * Yes No
I am currently prescribed medication for blood pressure or heart condition. * Yes No
I am pregnant or I have given birth in the last 3 months. * Yes No
I have asthma. * Yes No
I have diabetes. * Yes No
I have epilepsy. * Yes No

Acknowledgement
I do not know of any other reason why I should not exercise. *
I acknowledge that if I answered yes to any of the questions above I should talk to my doctor before any increase in activity. *
I will seek my doctor's advice and update staff should any of my answers change. *

Gym Membership (12 months)

Gym Membership (12 months)

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Emergency Contact Person *
Emergency Contact Phone *

Gym Membership (12 months)

Gym Membership (12 months)

Health Declaration

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