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1. Details Information

First Name *
Last Name *
Email Address *
Phone *
Address *
Date Of Birth* (MUST BE 18 YEARS & OVER TO BE ELIGIBLE)
Gender *
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2. Health Questionnaire

Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
Do you ever experience unexplained pains in your chest at rest of during physical activity / exercise?
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity / exercise?
Do you have any other medical conditions(s) that may make it dangerous for you to participate in physical activity/ exercise?
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