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    Regular exercise is associated with many health benefits. Increasing physical activity is safe for most people. However,
    some individuals should check with a physician before they become more physically active. Completion of this
    questionnaire is a first step when planning to increase the amount of physical activity in your life. Please read each
    question carefully and answer every question honestly:

    Health Questionnaire:

    I agree

    *IMPORTANT* If you have answered "YES" to any of the above questions you will be required to seek medical advice from your GP and attend a compulsory induction before using the fitness suite. Once you have done this please re-complete this form again.

    I have read, understood and completed the above questionnaire and acknowledge that there are risks and dangers inherent in physical exercise and duly undertake the activity at my own risk. Any liability on the part of the operators is excluded unless negligence can be proven. I agree to observe the rules and conditions of membership. I also acknowledge that I must not use any piece of equipment for which I have not been shown how to use by an instructor. I confirm that the information that I have provided is correct at this time and should I become aware of any relevant changes to my health or condition, I will inform an instructor.

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    Poyntz Lane
    NN5 7TZ

    Tel: 01604 59 29 29
    email: info@dallingtonfitness.co.uk



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