First name:____________________________Surname:______________________________

Date of birth: __________________________Contact number:________________________

Occupation: ___________________________Email:________________________________

Where did you hear about us:___________________________________________________

What is your main goal in health & fitness?________________________________________

What is your current fitness level (1=poor 10=excellent)?_____________________________

Health questionnaire (Please tick relevant box)

Have you ever had heart problems? Y __ N __

Have you ever had back problems? Y __ N __

Are you pregnant? Y __ N __

Have you ever had high blood pressure?  Y __ N __

Are you currently taking any prescribed or unprescribed medication?  Y __ N __

Do you suffer diabetes or epilepsy?  Y __ N __

Do you suffer any respiratory problems such as asthma?  Y __ N __

Do you have any bone or joint problems? Y __ N __

Do you have any other medical conditions (please state it yes) Y __ N _________________

In consideration of me being allowed to participate in the activities of UK Outdoor Fitness and to use the facilities and equipment owned and/or under the control of UK Outdoor Fitness, in addition to any payment or fee or charge, I do hereby waive, release and forever discharge UK Outdoor Fitness from any and all responsibility or liability for injuries or damages resulting from my participation in my activities or my use of equipment or facilities.

I understand and I am aware that strength, flexibility and aerobic exercise, including the use of equipment, in the outdoors, are potentially hazardous. I also understand that exercise and fitness activities involve a risk of injury and even death. I acknowledge, I am voluntary participating in these activities and using equipment and facilities with my 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 UK Outdoor Fitness staff, 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 and clothing. If I choose not to take their advice, or to disregard any advice given, I do so voluntary and accept liability for all resulting injuries or damage.

I do herby declare myself to be physically sound and suffering from no condition, impairment, disease or infirmity or any other illness, (other than on the signed medical questionnaire), that would prevent my participation or use of equipment or facilities except as herein stated.

I acknowledge that I have either had a physical examination and have been given permission by my doctor to participate, or that I have decided to participate without the approval of my doctor and do hereby assume all responsibility for my participation in the activities and use of equipment in my activities.

UK Outdoor Fitness cannot accept responsibility for any valuables left in the instructor?s vehicles whilst training is in progress.

Signature ________________________ Date _______________

Print Name_______________________

Please bring this completed form with you to your first session

(You will not be allowed to take part without this completed form)

UK Outdoor Fitness Ltd, 2 Clifton Moor Business Village, James Nicholson Link, York YO30 4XG
Tel: 07989586798 Email: enquiries@ukoutdoorfitness.com Registered in England No. 7117131