Name *

First Name

Last Name

Date of Birth *

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DD

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Emergency Contact Name *

First Name

Last Name

Do you now or have you had any of the following in the past? *

Please check all that apply.

History of heart problems, chest pain or stroke

Elevated blood pressure

Low blood pressure

Elevated blood cholesterol

Any chronic illness or condition

Difficulty with physical exercise

Advice from a physician not to exercise

Recent surgery in the last 12 months

Pregnancy now or within the last 3 months

History of breathing or lung problems

Muscle or joint injuries or issues

Previous soft tissue injuries

Diabetes

Metabolic Syndrome

Thyroid condition

Autoimmune condition

Obesity

History of disordered eating

Cigarette smoking habit

Do you drink alcohol