2018 Season

Contact Information
Name *
Name
Today's Date
Today's Date
Date of Birth
Date of Birth
Mailing Address
Mailing Address
Emergency Contact
Emergency Contact
Health
Has a doctor ever said that you have a heart condition? *
Have you ever had high blood pressure? *
Do you have any metabolic diseases, controlled or uncontrolled, such as diabetes, hyperthyroidism, hypothyroidism, etc.? *
Have you ever had a seizure, been diagnosed with epilepsy or another neurological disorder? *
Do you have a bone or joint problem that could be aggravated by the proposed physical activity? *
Are there any other physical, medical or emotional problems that may affect your training? Or that you think I should know about?? *
Are you, or have you ever been, anorexic or bulimic? *
Have you ever had an injury that caused you to stop exercising for more than 1 week? *
Are you aware, through your own experience or a doctor’s advice, of any other physical reasons against your exercising without medical supervision? *