Sign Up Form Pre Execise Questionnaire “In participating in the WG Fitness Program, you agree that we (being WG Fitness, its servants and agents) will not be liable for any personal injury, illness or death except where this results from our gross negligence. You acknowledge that our liability in such instances is limited to the full extent available under common law and the relevant New South Wales legislation.” Please also note, this information is hosted on a secure server and IS NOT accessible to the public, nor will it be shared. I take your privacy very seriously. NameFirstLastEmailDate of Birth - dd-mm-yyPhoneEmergency Contact / Name / NumberHave you ever suffered from the following:Heart Condition/Chest PainsHigh/Low blood pressureDiabetesThrombosis/poor circulationEpilespyRheumatic FeverLiver/Kidney conditionAsthmaArthritisMuscle/bone/joint problemsChronic BronchitisAlcohol/drug dependancyAnorexa/BulimiaAre you currently a smokerNoYesAre you pregnantNoYesAny other condition that may restrict physical activity?NoYesPlease explainAre you on medication?NoYesHave you had surgery in the last 2 years?NoYesPlease add some detail on the surgeryAre you currently excercising?NoYesShed some light on what you are currently doing pleaseHow long since you were actively excercising, and what we you doing then? What are you personal training objectives How did you discover WG Fitness
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