FAMILY MEMBERSHIP No contractAccess any time incl. all classesIt’s that simple!Please fill out the form.Billing occurs monthly unless cancelled. Person 1 * First Name Last Name Person 1 Phone * (###) ### #### Person 1 Email * How did you hear about us? Live locally/saw signs Word of mouth Instagram Other social media Google/website Person 1 - Do you have a heart condition, high blood pressure or other circulatory problems? * No Yes Person 1 - Do you have diabetes? * No Yes Person 1 - Do you ever experience pain in your chest when exercising or at rest? * No Yes Person 1 -Do you ever feel faint or suffer from dizzy spells? * No Yes Person 1 - Do you have back pain or joint conditions that could be exacerbated by exercise? * No Yes Person 1 -Do you have asthma? * No Yes Person 1 - Have you had any surgery in the past year that may affect your physical activity? * No Yes Person 1 - Are you aware of any other condition or injury that may give reason to modify your exercise programme? * No Yes Person 1 - Are you taking any medication? * No Yes Person 1 - Are you pregnant? Or have you given birth in the past six weeks? * No Yes Person 2 * First Name Last Name Person 2 Phone * (###) ### #### Person 2 Email * Person 2 - Do you have a heart condition, high blood pressure or other circulatory problems? * No Yes Person 2 - Do you have diabetes? * No Yes Person 2 - Do you ever experience pain in your chest when exercising or at rest? * No Yes Person 2 -Do you ever feel faint or suffer from dizzy spells? * No Yes Person 2 - Do you have back pain or joint conditions that could be exacerbated by exercise? * No Yes Person 2 -Do you have asthma? * No Yes Person 2 - Have you had any surgery in the past year that may affect your physical activity? * No Yes Person 2 - Are you aware of any other condition or injury that may give reason to modify your exercise programme? * No Yes Person 2 - Are you taking any medication? * No Yes Person 2 - Are you pregnant? Or have you given birth in the past six weeks? * No Yes Person 3 * First Name Last Name Person 3 Phone * (###) ### #### Person 3 Email * Person 3 - Do you have a heart condition, high blood pressure or other circulatory problems? * No Yes Person 3 - Do you have diabetes? * No Yes Person 3 - Do you ever experience pain in your chest when exercising or at rest? * No Yes Person 3 -Do you ever feel faint or suffer from dizzy spells? * No Yes Person 3 - Do you have back pain or joint conditions that could be exacerbated by exercise? * No Yes Person 3 -Do you have asthma? * No Yes Person 3 - Have you had any surgery in the past year that may affect your physical activity? * No Yes Person 3 - Are you aware of any other condition or injury that may give reason to modify your exercise programme? * No Yes Person 3 - Are you taking any medication? * No Yes Person 3 - Are you pregnant? Or have you given birth in the past six weeks? * No Yes Person 4 * First Name Last Name Person 4 Phone * (###) ### #### Person 4 Email * Person 4 - Do you have a heart condition, high blood pressure or other circulatory problems? * No Yes Person 4 - Do you have diabetes? * No Yes Person 4 - Do you ever experience pain in your chest when exercising or at rest? * No Yes Person 4 -Do you ever feel faint or suffer from dizzy spells? * No Yes Person 4 - Do you have back pain or joint conditions that could be exacerbated by exercise? * No Yes Person 4 -Do you have asthma? * No Yes Person 4 - Have you had any surgery in the past year that may affect your physical activity? * No Yes Person 4 - Are you aware of any other condition or injury that may give reason to modify your exercise programme? * No Yes Person 4 - Are you taking any medication? * No Yes Person 4 - Are you pregnant? Or have you given birth in the past six weeks? * No Yes Thank you!
