Pre Exercise Screen form

Please fill out our pre exercise Screen Form

Waiver and Release Form

First Name *

Last Name *

Date of birth *

Address *

City *

Postal code *

Phone *

Has your medical practitioner ever told you that you have a heart condition or have you ever suffered from a stroke? *

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise? *

Do you ever feel faint, dizzy or lose balance during physical activity/exercise? *

Have you had an asthma attack requiring medical attention at any time over the last 12 months? *

If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months? *

Do you have any other conditions that may require special consideration for you to exercise?

If you ANSWERED 'YES' to any of the 6 questions, please seek guidance from an appropriate allied health professional or medical practitioner prior to undertaking exercise.

I acknowledge, agree and represent that I AM IN GOOD HEALTH and in PROPER PHYSICAL CONDITION to participate in physical activity. I understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights to hold Underground Strength Gym Liable in any way (Sign below) *

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