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  Name Surname
  Date of birth Sex
  Address
  Postcode
  Email Confirm Email
  Password Confirm password
  Mobile
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  Enrollment Details
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  Course Commencement Date
  Course Fees  
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  T-Shirt Size
  Payment Method Cash By Cheque Bank Transfer

  Medical/Health Form Pre-Exercise Questionaire
  Any major illnesses or disabilities?
  Are you presently exercising? Yes No
  Brief outline
  Have you been hospitalised recently? Yes No
  Do you suffer from any of the following?
 
Heart disease Yes No Asthma Yes No
Heart Condition Yes No Diabetes Yes No
Back pain Yes No Epilepsy Yes No
Spinal Injuries Yes No Hernia Yes No
Arthritis Yes No Heart Palpitations Yes No
Joint pains Yes No Hi/low Blood Pressure Yes No
Tightness in Chest Yes No Rheumatic Fever Yes No
Liver/Kidney Condition Yes No Regular Headaches Yes No
Infections Yes No Muscular pain/cramps Yes No
Chronic Cough Yes No High Cholesterol Yes No
Are you pregnant? Yes No Allergies to Grass? Yes No
Bladder Weakness? Yes No    
  Are there any conditions that may limit your physical activity? Yes No
  Are you Male>35yrs unaccustomed to exercise? Yes No
  Are you Female>45yrs unaccustomed to exercise? Yes No
  Comments
  Yes, details above reflect my current medical & health condition

 
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