Registration form — Creighton Personal Training

Registration

Name

First Name

Last Name

Email Address

Date of birth

Post code

Contact Number

How did you hear about us?

Emergency Contact Name and Number

Do you suffer from the following

Chest Pain/Palpitations

Low/High Blood Pressure

Currently Pregnant

Heart condition

Epilepsy

Stroke

Diabetes

Infectious Diseases

None of the above

Have you had illness in the past 12 months?

Is there any illness or injury that may affect your training

Do you suffer from any knee, shoulder, hip or other pain?

I understand the questions above & my answers are true and correct. I will not have any claim against Creighton Personal Training or my instructor for any illness, injury or adverse change in medical condition arising directly/indirectly from any program carried out.

Goals

What are you wanting to get out of training?