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Fitness Enrollment Form
Fill out the form to register
1
Step 1
2
Step 2
Member's Name:
First Name
Last Name
This field is required.Please enter value
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Gender:
Male
Female
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Date of Birth:
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Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Phone No.:
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Invalid phone number.
The value must be less than or equal to 20
E-mail:
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Please enter valid email address
Coach Name:
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Coach Mob No.:
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Invalid phone number.
The value must be less than or equal to 20
Guardian's Name & relationship:
This field is required.Please enter value
Mob No.:
This field is required.Please enter value
Invalid phone number.
The value must be less than or equal to 20
Describe any physical activity or exercise program that you do somewhat regularly:
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Does your physician know you are participating in this exercise program:
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Are you not feeling well,then mention your Sick name and Medications:
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Present Date:
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Date format is invalid, please check it again
The value must be greater than or equal to -21474836487
The value must be less than or equal to 2147483647
Next
Do you now, or have you in the past had::
YES
NO
1. History of heart problems, chest pain, or stroke
2. Increased/High blood pressure
3. Any chronic illness or condition
4. Difficulty with physical exercise
5. Advice from a physician not to exercise
6. Recent surgery (last 12 months)
7. Pregnancy (now or within last 3 months)
8. History of breathing or lung problems
9. Bone, ligament, or tendon problems
10. Muscle or joint problem (specify: neck, back, shoulder, knee, hip, or other)
11. Diabetes or thyroid condition
12. Obesity (more than 20% over ideal body weight)
13. Increased blood cholesterol
14. History of heart problems in immediate family
15. Hernia, or any condition that may be aggravated by lifting weights
If "Yes" then mention your answers here:
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Signature:
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