Consent & waiver, classic form
Gym waiver and health declaration template (classic)
A membership health declaration with medical clearance, conditions and medications, a risk acknowledgement, emergency contact and signature.
10 questions, 9 required, as a classic form
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Every question
Full name (required)
Full name
Date of birth (required)
Date
Mobile (required)
Short answer
Membership (required)
Dropdown: Open gym, 24/7 access, Coached strength classes, Open gym and classes, 10 visit pass
Has a doctor ever told you that you have, or do you have, any of the following? (required)
Multiple choice: A heart condition, stroke or high blood pressure, Chest pain, faintness or dizziness during exercise, Diabetes, epilepsy or another condition that can cause collapse, A bone, joint or muscle problem made worse by exercise, Pregnancy now, or a birth in the last six months, Surgery in the last twelve months, None of these
If you ticked a condition, has a doctor or physiotherapist cleared you to train? (required)
Single choice: Yes, I have clearance, No, I will get it before my induction, I ticked none of these
Conditions, injuries or medications your coach should know about
Long answer
Acknowledgement (required)
Multiple choice: I have read the risks above, my health answers are true, and I will update them if they change
Emergency contact name, relationship and phone (required)
Short answer
Signature (required)
Signature
What you fill in
- [Your company]
- [Your suburb]