Your #1 Bootcamp & Run Club in West London

Questionnaire

Before you join in a class, please complete this short form. It will only take a minute at the most and then you’ll be on your way.

I need this for legal reasons!

Please leave this field empty.

About You

Your Title*

Your First Name*

Your Surname*

Your Email*

Your Date of Birth*

Your Age*

Your Telephone Number*

Your Address

House / Flat Name /Number and Street Address*

City*

Your postcode*

Start Date & Comments

When do you want to start? (Please indicate time & day, e.g. Monday 6:45am)
Add in any other comments here also.

Health Questionnaire:

Please complete this questionnaire, select ‘Submit’ and we’ll send you a copy to print out and bring with you to your first class…

1. Has your doctor ever said you have heart trouble?*
YesNo

2. Have you ever had pains in your chest?*
YesNo

3. Do you often feel faint or have spells of dizziness?*
YesNo

4. Has a doctor said your blood pressure is too high?*
YesNo

5. Has a doctor said that you might have bone or joint problems, such as arthritis, that has been aggravated by exercise or might be made worse with exercise?*
YesNo

6. Have you been in hospital in the last 3 years?*
YesNo

7. Are you currently taking any medication?*
YesNo

8. Are you pre/post natal?*
YesNo

9. Do you suffer from asthma, or breathing difficulties?*
YesNo

10. Do you suffer from diabetes or epilepsy?*
YesNo

11a. Do you suffer from an allergy?*
YesNo

11b. If you answered 'Yes' in 11a what medication do you take?

12a. Is there a good physical reason not mentioned here why you should not follow an activity programme?*
YesNo

12b. If you answered yes to question 12a, please give more details here.

How would you describe your current level of fitness?*

Very fitFitAverageUnfitNone at all

Agreement and conditions of joining:

1. I am aware of and understand the potential risks and dangers associated with physical activity including the use of equipment and I am voluntarily participating in these activities with knowledge of the risks and dangers involved.

2. I understand that exercise and fitness activities in the outdoors involve a risk of injury or even death and that I am voluntarily participating in these activities and using equipment and facilities with knowledge of the dangers involved. I hereby agree and expressly assume all and any risks of injury or death.

3. I know of no reason why I should not participate in any of the programmes and activities at Rocket Sports Fitness. I hereby declare myself free of any condition, disease, infirmity or illness that may affect my participation. I agree to inform a member of staff and where appropriate provide written consent from my doctor should such a condition or complaint arise before continuing with any activity.

4. I agree to abide by all oral notices regarding safety whilst at a Rocket Sports Fitness class. I am aware I have the opportunity to ask questions about the activities, general use of equipment and other related issues at class. If I choose not to take the advice or to disregard any advice given, I do so voluntarily and accept liability for all resulting injuries or damage.

5. I do hereby waive, release and discharge Rocket Sports Fitness, Rocket Sports Ltd and anyone associated with either company from any and all responsibility or liability for injuries or damages resulting from my participation in any activities or my use of equipment or facilities in the above mentioned activities.

6. This questionnaire has been completed accurately to the best of my knowledge and belief.

I have read, understood and completed this questionnaire and by clicking on ‘SUBMIT’ I agree to be bound by its conditions.

Skip to toolbar