Emergancy Contact Name & Number

If you have children, what ages are they?

Have you ever had a Heart Conditions that would affect you exercising?

Do you feel pain in your chest when you do physical exercise?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

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

Do you suffer from hay fever/sinus problems?

Do you suffer from migraines/frequent headaches?

Have you ever had a sports injury?

Have you ever had arthritis/osteoarthritis?

Do you have a bone or joint problem (e.g. back, knee or hip) that has been aggravated by exercise or could be made worse by a change in physical activity?

Do you have either high or low blood pressure and if yes, which type?

Are you currently on any prescribed medication that may affect your ability to exercise?

Are you pregnant?

Have you had a baby in the last 6 months?

Describe any current or past conditions, illnesses/injuries not already highlighted above.

Do you know of any other reason that would affect your ability to participate in physical activity?

I understand that We Are Fit Attitude is not able to provide me with medical advice with regard to my medical fitness; this information is used as a guideline to the limitations of my ability to exercise. I will not hold We Are Fit Attitude liable in any way for injuries that occur while participating in this program.