Gym Pass Health Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.YOUR DETAILS Name *FirstLastEmail *Phone Number *Address *Address Line 1Address Line 2CityCountyPost CodeDate of Birth * YOUR PHOTO Please upload a passport style headshot File Upload Click or drag a file to this area to upload. EMERGENCY CONTACT DETAILS Name *Phone CODE FITNESS PHYSICAL ACTIVITY QUESTIONNAIRE Has a medical professional ever advised that you have heart problems or that you are at risk of having them? * *NoYesDo you frequently have pains in your heart or chest? *NoYesDo you tend to lose conciousness or fall over as a result of dizziness? *NoYesDo you have a bone or joint problem that could be or has been aggravated by exercise? *NoYesHas your doctor ever recommended medication for your blood pressure, cholesterol or a heart condition? *NoYesHave you been diagnosed with diabetes? *NoYesAre you aware, through your own experience or a doctor’s advice, of any other physical reason against your exercising without medical supervision? *NoYesAre you over the age of 65 and not accustomed to vigorous exercise? *NoYesHave you had any serious injuries or operations including breaks and sprains throughout your life? If YES please give brief details below *NoYesDetails of injuries * If you answered YES to one or more of the above questions, please answer the following questions: Have you consulted with your physician regarding increasing your physical activity and/or performing a fitness assessment? * *NoYesIf you answered no to the question above, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment? We at Code Fitness recommend that you do seek the advice of a medical professional. *NoYesIf you answered no, in doing so you accept that you are training at your own risk and we at code fitness are not liable. We at code fitness recommend that you seek the advice of a medical professional. CODE FITNESS TERMS & CONDITIONS T&Cs *I accept the gym facilities terms and conditionsI accept the health and safety poilcyRead our terms and conditions and health and saftey policy Before hitting submit, check that you have filled in all of the required fields above then hit submit once for it to register… Submit