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First Name
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Last Name
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Phone
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Email
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Address
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City
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Postal code
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Emergency Contact
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Please provide details if you have any of the following medical conditions: Heart Problems, High/Low Pressure, High Cholesterol, Chest Pain/Angina, Diabetes, Asthma, Epilepsy, Bone or Muscle Issues or if you are taking any medication for these conditions ?
Can you provide us with any medical information as to why you should not exercise or if you have any pre existing medical conditions we must know about ? e.g. Joint Issues or Muscle Issues ?
Are you pregnant, or have in the last 3 months ?
Do you or have you ever suffered from back or neck pain ?
Medical Information
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Please tick that you have given all relevant medical details
Please sign if you have read the Terms & Conditions*
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