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A. If you are a new client firstly, please fill out our health questionnaire below. If you are an existing client, please proceed straight section B. below:
Today's Date
*
DD slash MM slash YYYY
Name
*
First
Last
Email
*
Phone
*
DOB
*
DD slash MM slash YYYY
Preferred Method Of Contact
Email
Telephone
What are you interested in?
*
Outdoors Group Training
Virtual / Zoom Training
Both
What do you want to achieve by exercising?
Weight loss / fat loss
Improve Fitness
Gain self esteem / improve self esteem
Support emotional health (anxiety)
Gain more energy
Tone up / get stronger
General wellbeing / fitness
Have fun & meet new people
Do you have any previous, or existing injuries, joint complaints, or medical conditions?
Please mention below:
Are you currently exercising?
Yes
No
Share with us more of your goals, concerns, questions and how we can help you:
Membership Terms & Conditions
All memberships are an ongoing recurring weekly (direct debit) or upfront term payment. Memberships are a 10 week/ term commitment and can only be changed / cancelled after the 10 week term is complete.
Signature & Date Please:
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Name
This field is for validation purposes and should be left unchanged.
B. Secondly, lets set up your payment details:
Seniors Pass (upfront)
$
144.00
Access to the weekly seniors class on Friday’s.
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