We Fit Together Health Screening Form - Post Natal Fitness Classes Glasgow

Name*

Enter your full name

Date of Birth*

date of birth

Address*

Your Address

Phone Number*

Your Phone Number

E-mail*

Enter a valid email

Occupation*

Your Occupation

Doctor*

Your Doctors Name

Doctor's Telephone Number*

Your Doctors Telephone Number

Previous Exercise Taken*

exercise previously taken

Number of Children*

How many other children do you have

Other Relevant Medical Information:

Is there anything else in your medical history that could affect your ability to exercise?

Are you taking any medication?:

Please give details of any medication taken

What are your goals or reasons for participating in exercise?

Please list your primary reasons/goals here

Are you doing other exercise?*

Detail any other exercise you are currently doing

Please read and sign

I, acknowledge and confirm that I have had the all clear by my GP to commence suitable exercise. I am aware that I must feel well prior to each session and will notify you (the trainer) should I feel unwell at any time during the class.

Social media is a great promotional platform for us- We may take informal photos or video at class to help with our promotion, but we respect your wishes so please delete appropriately.

Data Protection: The information you have provided here will be used for WeFitTogether purposes only by your Trainer, we understand that some data in sensitive and treat this the way of a medical practitioner no data will be shared with any third party without your prior permission.

I hereby consent for you to process and store my information for at least 7 years for professional and legal purposes and my consent will be sought before it is shared with anyone outside of WeFitTogether. However I understand that these details may be shared in the event of a medical emergency.

I give you permission to contact me for marketing purposes in the future.*

I give you permission to contact me re Buggyfit classes & social events.*

I am happy with the following methods of contactMobileEmailHome Phone

I confirm that all statements on the form are correct and that I have read and understand this declaration.

Signed*

Today's Date*

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