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