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Kickbox N Bop Fitness Questionnaire
Name
DOB
Email
Phone
Emergency Contact Name
Emergency Contact Phone Number
Is there anything your instructor needs to know?
Medical Questionnaire
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High or Low blood pressure?
Elevated blood cholestorol?
Chest pains brought on by physical excercise?
Epilepsy?
Dizziness or fainting?
A bone, joint or muscular pain with arthiritus
Asthma?
Any sustained injuries or illnesses?
Any allregies?
Are you taking any medication?
Has your doctor ever advised you not to exercise?
Are you registered as Disabled?
Do you have any additional needs? (Learning difficulties, ADHD, Austism)
No to all of the above
If yes to any of the above, please give us more detail
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