Name *

First Name

Last Name

Please tick if you suffer from any of the below conditions:

Leave blank in the event that you do not.

High blood pressure

Low blood pressure

Diabetes or any other metabolic disease

Raised cholesterol (serum level above 6.2mmol/L)?

Heart condition that you should only do physical activity recommended by a doctor?

Have you ever felt pain in your chest when when you do physical exercise?

Is your doctor currently prescribing you any drugs or medication?

Have you ever suffered from unusual shortness of breath at rest or with mild exertion?

Is there any history of Coronary Heart Disease in your family?

Do you often feel faint, have spells of severe dizziness or have lost consciousness?

Do you currently drink more than the average amount of alcohol per week (21 units for men/14 units for women)?

Please select I ACCEPT if you agree that: *

· You have read, understood and answered honestly the questions in this questionnaire. · You wish to participate in activities, which include intense resistance exercise and stretching. · You realise that your participation in these activities involves the risk of injury and even the possibility of death. · You represent that you are medically and physically able to safely participate in the Services including any fitness programs or participation in any physical or related activity (including your participation in nutritional programs) provided by GPT and to meet the physical demands thereof. · You assume all risks associated with your participation in the Services. · If at any time hereafter you have any medical or physical limitation or condition that might affect your ability to safely participate in the Services or meet the physical demands required thereof, you will make such limitations and conditions immediately known to GPT.

I ACCEPT