21 day Challenge - Easter

Athlete/Client 1

Athlete/Client Details

Enter the password that you would like to use for your new account.

Address

Health and Fitness

Training Dates

From 04-Mar-2016 to 24-Mar-2016

Training Days & Times

Once a time slot is full you will be asked to make another choice.

Time Mon Tue Wed Thu Fri
5:30 - 6:30 am
Vector Health 102 William Street
Vector Health 102 William Street
Vector Health 102 William Street
Vector Health 102 William Street
Vector Health 102 William Street
5:30 - 6:30 pm
Vector Health 102 William St
Vector Health 102 William St

DISCLAIMER:
I hereby agree to assume all risks and responsibilities surrounding my (or my child's) participation in the program under the instruction of Vector Health coaches. I understand that similar to all sporting activities, there is a risk of damage to personal property, injury or death which may result from causes beyond the control of, and without fault or negligence of Vector Health, its officers, agents, or employees, during the period of my (or my child's) participation. I understand completely the above agreement and agree to be bound thereby. By registering on our site you agree that we may send you email related to our facilities and programs. We will not provide your details to any other company.

Agreement

       /         /        

Payment Method

There are no refunds for any enrolments into Vector Health related programs. When you sign/tick confirmation for this enrolment you are acknowledging that you know this as a fact and have accepted it as a condition.
PayPal (Credit Card or PayPal Account)
Credit Card (Ezidebit)

Please mail this form with a payment attached to: "Vector Health, 102 William Street , Rockhampton QLD 4700"

03. ASSESSMENT. 01. APSS Screening Tool

COMPULSORY Adult Pre-Exercise Screening Tool - STAGE 1 only. This questionnaire determines a level of health risk. It is very important that you are upfront and honest with your answers. Answering NO to any of these questions does not mean you cannot do exercise, however it does mean that you present with a risk factor for injury or illness during or post physical activity or exercise.

Who is your normal General Practitioner?
What medical Clinic is your General Practitioner from?
Has your doctor ever told you that you have a heart condition or have ever suffered a stroke?
Yes
No
Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise
Yes
No
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
Yes
No
Have you had an asthma attack requiring immediate medical attention at any time over the past 12 months?
Yes
No
If you have diabetes (Type I or type II) have you had trouble controlling your blood glucose in the last 3 months?
Yes
No
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?
Yes
No
Do you have any other medical conditions that may make it dangerous for you to participate in physical activity/exercise
Yes
No
Have you had any injuries or illnesses in the past that stopped you from exercising or working? If yes, please provide details to help us with programming or providing you with advice.