Free Trial

Contact Details

First Name :

Surname :

Date of Birth :

Address :

Postcode :

Contact Number :

Email Address :

Occupation :

Where did you hear about us :

Your goals

What are you looking to achieve ?

Why are you looking to achieve this ?

When would you like to achieve this ?

What are you prepared to do to achieve this ?

Health Details

Have you ever have heart trouble ?
 Yes
 No

Have you ever suffered from chest pains ?
 Yes
 No

Do you ever feel faint or have spells of dizziness ?
 Yes
 No

Do you have high blood pressure?
 Yes
 No

Do you suffer from bone or joint problems ?
 Yes
 No

Have you been in hospital in the last 2 years ?
 Yes
 No

Are you currently taking any medication ?
 Yes
 No

Are you pre or post natal ?
 Yes
 No

Do you suffer from breathing difficulties ?
 Yes
 No

Are you diabetic ?
 Yes
 No

Are you epileptic ?
 Yes
 No

Do you have any allergies ?
 Yes
 No

Do you smoke ?
 Yes
 No

Do you have any medical problems or injuries not mentioned here that may be effected by taking part in physical activity ?
 Yes
 No

If you have answered yes or are unsure about any one of the questions please consult with your doctor before participating in our fitness bootcamp training program.

Consent

In consideration of being allowed to participate in the activities and programmes of Diverting Fitness and to use the facilities and equipment owned and/or under the control of Diverting Fitness, in addition to the payment of any fee or charge, I do hereby waive, release and forever discharge Diverting Fitness 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.

I understand and I am aware that strength, flexibility and aerobic exercise, including the use of equipment, in the outdoors, are potentially hazardous activities. I also understand that exercise and fitness activities involve a risk of injury and even death, and that I am voluntarily participating in these activities and using equipment and facilities with the knowledge of the dangers involved. I hereby agree to expressly assume and accept all and any risks of injury or death.

I am aware that I have the right to request advice from any of Diverting Fitness staff, at any time, in relation to the activities and exercise being undertaken and, but not exclusively, their suitability for me, with particular regard to my health and clothing. If I choose not to take advice, or to disregard any advice so given, I do so voluntarily and accept liability for all resulting injuries or damage.

I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease or infirmity or other illness (other than those declared on the attached medical questionnaire) that would prevent my participation or use of equipment or facilities except as herein stated. I acknowledge that I have either had a physical examination and have been given my doctors permission to participate, or that I have decided to participate in activity and use of equipment and machinery without the approval of my doctor and do hereby assume all responsibility for my participation and activities, and utilisation of equipment and machinery in my activities.

In addition Diverting Fitness cannot accept responsibility for valuables left in the instructor’s vehicles.

I have read and understood the above Consent-Liability Waiver ?
 Yes

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