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Pre-Activity Induction Health Questionnaire

Pre-Activity Gym Induction Health Questionnaire

Please note: This form should ONLY be completed if it has been requested in advance of a Gym induction .

If you have any difficulties completing this form  then please talk to a member of staff.

Personal Information

Name
Name
First
Last

Emergency Contact Details

Name
Name
First
Last
Can this Person be contacted at any time?
If No Give Secondary Emergency Contact
If No Give Secondary Emergency Contact
First
Last

GP Information

Surgery Name and Address
Surgery Name and Address
Town
County
Post Code
In the event of health conditions and/or emergency, do you consent for Bridge to contact your GP for further information relating to said condition/emergency?

Please Note that you must complete and send this form in to the gym instructor prior to using the Gym.