Pre-Exercise Screening Form

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Thank you for your response. ✨

Today’s date

YYYY-MM-DD

Name

Date of Birth

YYYY-MM-DD

Phone Number

Emergency Contact Name

Emergency Contact Phone Number

Which session/s are you interested in? (Ladies/Men/Kids/Sports Club, Location Time, Day/s)

Names and ages of children (if relevant)

Medical:

Do you have any injuries or concerns with your body? Eg. Low blood pressure/ High blood pressure/ Dizziness/ Allergies/ Surgeries within the last 5 years/ Osteoporosis/ Respiratory problems/ Past illnesses/ Joint, muscle or bone issues/ Pelvic floor concerns/ Pregnancy/ Other.

Declaration:

I understand that acceptance of my participation in an OSX Personal Training exercise program is based solely on the above information concerning my current state of health, which shall be the sole evidence of my fitness to participate in an exercise program. In consideration of my acceptance to participate in an exercise program, I hereby waive for myself, my heirs, executors and assignees, all claims from all rights, demands and charges at law which may arise from my, and that of my participation in any OSX Personal Training sessions – outdoor, online, group or individual. I agree to notify my trainer of any new injuries or issues, and if I don’t feel comfortable participating in a particular exercise, I will speak up knowing I will be offered a variation of that exercise. I agree to assume full responsibility for any risks, injuries or damage known or unknown which I or my child may incur as a result of attending and/or participating in the programs, classes or use of equipment. I acknowledge that children in my care accompanying me to a session, are my sole responsibility, and not that of the trainer, other children or members. Please indicate your acceptance of this statement by typing your name below.

By checking this box, I agree representatives of OSX Personal Training can use images on social media and the OSX Personal Training website that may include my children or myself. (We’ll always make sure they’re winners!)

Thank you! We can’t wait to have you join us.

Yours in health and fitness,

Team OSX

STRONGER • FITTER • BETTER • TOGETHER

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