Online Registration Form

REGISTRATION/MEDICAL HISTORY/WAIVER FORM

Before beginning any exercise program, consult with your physician.

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Before beginning any exercise program, consult with your physician.

Name*
Address
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Medical History
Have you now or have you had in the past:
History of heart problems, chest pain or stroke?
Increased blood pressure or blood cholesterol?
Any chronic illness or condition?
Difficult with physical exercise?
Advice from physician not to exercise?
Recent surgery (last 12 months)?
Pregnancy (now or within the last 3 months)?
History of breathing or lung problems?
Muscle, joint or back disorder, or any previous injury still affecting you?
Diabetes or thyroid condition?
Cigarette smoking habit?
More than 20% over ideal body weight?
Increased blood cholesterol?
History of heart problems in the immediate family?
Hernia or any condition that may be aggravated by lifting weights?
Are you currently on any medications?
Emergency Contact
Physician