Health Form


Please complete the following registration form. It will take just 5 minutes and you will be ready to train.
[contact-form subject=’Membership Registration New Trainees’]

Registration Form

Step 1 of 3

Your Details

[contact-field label=’Title’ type=’text’ required=’1’/][contact-field label=’First Name’ type=’text’ required=’1’/][contact-field label=’Surname’ type=’text’ required=’1’/]

[contact-field label=’Address 1′ type=’text’ required=’1’/][contact-field label=’Address 2′ type=’text’/][contact-field label=’Address 3′ type=’text’/][contact-field label=’Town’ type=’text’ required=’1’/][contact-field label=’County’ type=’text’ required=’1’/][contact-field label=’Postcode’ type=’text’ required=’1’/]

About You

[contact-field label=’Age’ type=’text’ required=’1’/][contact-field label=’Height’ type=’text’ required=’1’/][contact-field label=’Body weight?’ type=’text’ required=’1’/]

Contact Details

We require at least one telephone number.

[contact-field label=’Primary Contact Telephone No.’ type=’text’ required=’1’/][contact-field label=’Secondary Contact Telephone No.’ type=’text’/]

[contact-field label=’Email’ type=’email’ required=’1’/][contact-field label=’Confirm Email’ type=’text’ required=’1’/]

In the case of emergency your contact person is:

[contact-field label=’Name’ type=’text’ required=’1’/][contact-field label=’Telephone’ type=’text’ required=’1’/]

How did you hear about Urban Women Fitness?

[contact-field label=’I first heard about UWF from’ type=’text’ required=’1’/]

Free Newsletter

We send out a monthly e-newsletter updating you with information about camp, training and news.
[contact-field label=’I want to subscribe:’ type=’radio’ required=’1′ options=’Yes,No’/]

Step 2 of 3

PAR-Q (Physical Activity Readiness Questionnaire)

Nearly there…

Fitness

[contact-field label=’How often do you train?’ type=’text’ required=’1’/][contact-field label=’When was the last time you regularly trained?’ type=’text’ required=’1’/][contact-field label=’How would you describe your current fitness level’ type=’radio’ required=’1′ options=’Unfit,Returning to fitness training,Fit,Very Fit’ required=’1’/][contact-field label=’Current & Past Training’ type=’textarea’ /]

Please let us know your goal, event or reason for training

[contact-field label=’I am training for:’ type=’text’/]

Step 3 of 3

The last few questions…

Health

[contact-field label=’Has your doctor advised you that you should not do any physical exercise or training’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Are you post natal?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Do you suffer from asthma, or breathing difficulties?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Have you been in hospital in the last 3 years?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Are you taking any medication?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Do you suffer from diabetes or epilepsy?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Do you suffer from an allergy?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Do you feel pain in your chest when you do physical activity?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’In the past month, have you had chest pain when you were not doing physical activity?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Do you lose your balance because of dizziness or do you ever lose consciousness?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Do you have a bone or joint problem that could be made worse by a change in your physical activity?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Is your doctor currently prescribing drugs (ex. water pills) for your blood pressure or heart condition?’ type=’radio’ required=’1′ options=’Yes,No’/]
[contact-field label=’Do you know of any other reason why you should not do physical activity?’ type=’radio’ required=’1′ options=’Yes,No’/]

[contact-field label=’If you answered yes to any of the above questions , please provide more information:’ type=’textarea’/]

If you answered:

Yes to one or more questions

  • Talk with your doctor by phone or in person before you start becoming much more physically active and before you start training. Tell your doctor about the PAR-Q, your intended training and which question(s) you answered YES.
  • You may be able to do any activity you want as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advise.

No to all questions

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

  • Start becoming more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.
  • Take part in an exploratory session to use as a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

  • If you are not feeling well because of a temporary illness such as a cold or fever – wait until you feel better.
  • If you are pregnant – talk to your doctor before you start becoming more active.
  • If your health changes so that you then answer YES to any of the above questions, consult your doctor. Similarly, if at any stage your details change, then it is your responsibility to complete a new PAR-Q Form.

Membership Terms and Conditions

Disclaimer

Please read the following documents before proceeding:

  • The full Disclaimer which includes ‘Risk Factors’ click here.
  • The Membership Full Terms and Conditions click here.

[contact-field label=’I understand that participation in training activities involves a certain degree of risk and can be physically, mentally, and emotionally demanding or can even lead to death. I also understand that participation in these activities is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. ‘ type=’checkbox’ required=’1’/]

[contact-field label=’This form has been completed accurately to the best of my knowledge and belief.’ type=’checkbox’ required=’1’/]
[contact-field label=’I have read, understood and completed this form and by ticking this box I agree to be bound by its conditions.’ type=’checkbox’ required=’1’/]
[contact-field label=’I have read and agree to the Membership Full Terms and Conditions & Disclaimer’ type=’checkbox’ required=’1’/]

[contact-field label=’I understand that I need to I should cancel my session 24 hours before the time of the session or I may not be able to recover it’ type=’checkbox’ required=’1’/]

Thank you for completing your Registration booking form.

PLEASE PRESS THE BUTTON BELOW TO SUBMIT

[/contact-form]