Multi-Sport Camp

Dates

Tuesday - 15th April
Wednesday - 16th April
Thursday - 17th April
Tuesday - 22nd April
Wednesday - 23rd April
Thursday - 24th April

Parent Name *

First

Last

Email *

Phone *

How did you hear about us?

Child's Name *

First

Last

Child's Date of Birth *

What is your child interested in? *

Please complete the medical consent form below

Before signing up to any of our camps, we need you to complete the below medical information.

Have you ever been told that you have a heart condition?*

Yes
No

Have you ever had a stroke?*

Yes
No

Do you ever have unexplained pains in your chest at rest or during physical exercise?*

Yes
No

Do you consistently feel faint or suffer from spells of dizziness?*

Yes
No

Do you suffer from asthma and require medication?*

Yes
No

Do you suffer from Type 1 or 2 diabetes?*

Yes
No

Do you suffer from any major muscle or joint conditions that may limit you or be aggravated by physical activity?*

Yes
No

Do you suffer from any medical conditions that may be worse by participating in physical activity?*

Yes
No

Do you suffer from high blood pressure over 140/90 or low blood pressure below 100/80?*

Yes
No

Do you have any family history of heart disease? (i.e. strokes, heart attacks)*

Yes
No

Have you been diagnosed with high cholesterol?*

Yes
No

Have you been told that you have high blood sugar?*

Yes
No

Have you spent time in hospital for any injury/illness/condition over the past 12 months?*

Yes
No

If you have answered any YES to any of the above, please could you provide further information.*

Are you currently taking any medication? If so, please provide further information.

Disclaimer: if you have answered no to all of the above questions and you are confident that you have no other concerns with your health then you may proceed to participate in physical activity. If you have answered yes to any of the above questions, or are unsure, please seek a referral from your GP or allied healthcare professional before commencing physical activity. *

I believe to the best of my knowledge that all of the information that I have provided on this tool is accurate. In the case that my medical condition changes over the course of my training, I will informer my trainer and fill out a new exercise pre-screening questionnaire.

GDPR Agreement (copy) *

I consent to having this website store my submitted information so they can respond to my inquiry.

I also give permission for my child to be photographed/filmed, and for the images to be used in social media.

Sign up to our Mailing List