*

First Name

Last Name

Name *

First Name

Last Name

*

Select the location(s) and time you would like to attend.
 If you need to change any sessions to another location or time, comment below or contact Rob on 0400 015 030.

Bootcamp: North Adelaide 6am

Bootcamp/LIFE (Hybrid): North Adelaide 6pm

Bootcamp/LIFE (Hybrid): North Adelaide 5:45am

Bootcamp: Henley Beach 6am

1. Has your medical practitioner ever told you that you have a heart condition or have you ever suffered a stroke? *

Yes

No

2. Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise? *

Yes

No

3. Do you ever feel faint, dizzy or lose balance during physical activity/exercise? *

Yes

No

4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months? *

Yes

No

5. If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months? *

Yes

No

6. Are you pregnant? *

Yes

No

7. Do you have any other conditions that may require special consideration for you to exercise? *

If you select yes, please give details below at the base of this form.

Yes

No

8. Frequency (number of sessions per week) *

In active for more than 3 months

2-3 sessions per week

4-5

6+

9. Family history of heart disease? *

A family history of heart disease refers to an event that occurs in relatives including parents, grandparents, uncles and/or aunts before the age of 55 years.

Yes

No

10. Do you smoke cigarettes? *

Yes

No

11. Have you been told that you have high blood pressure? *

Yes

No

12. Are there any conditions that may limit your physical activity ? *

If you selected YES, please give details below.

Yes

No

Participants Declaration *

By submitting this form, I declare that the information given in this form is true and complete to the best of my knowledge. I understand that all participants take part at their own risk and must accept personal liability for any injury, illness or loss. I declare that I consider myself to be in good health and fit to participate in my chosen Athletica program. I hereby represent to Athletica, its management, associated companies, trusts, partnerships and other legal entities, their directors, officers, employees, agents, contractors and affiliates that I am physically capable of and there is no medical reason to prevent me from proceeding with any program run by Athletica without endangering my health. I acknowledge that whilst participating in the Athletica program, my person and my property are at my own risk. I acknowledge that I will not hold Athletica responsible for and Athletica hereby excludes, to the extent permitted by law, all liability for any personal injury or damage {whether direct, indirect, special or consequential} suffered by me while I am participating in Athletica program however that injury, damage or loss is caused, including if it is caused by the negligence of Athletica. I acknowledge that except as provided in this document, Athletica gives no warrantee in respect to the services and equipment it provides. I accept that there are no rain checks, refunds or make up days unless at the discretion of Athletica. I hereby permit Athletica to utilise any images and video of myself for promotional or marketing use of the Athletica program. I hereby release and will indemnify Athletica for any injury or loss suffered by me whilst participating in any Athletica program. I have read, understood and agree to the terms and conditions of Athletica.

Yes