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ISLE OF WIGHT FITNESS – HEALTH & CONSENT FORM

Name: _______________________________________

Email: _______________________________________

Mobile:_______________________________________
Emergency Contact (name & number): ___________________

Mailing List/Whatsapp (class updates): YES / NO
Photo/Video Consent (for promotion): YES / NO

HEALTH SCREENING (PAR-Q) Please circle YES or NO:

Heart condition / advised to exercise under medical supervision? YES / NO
Chest pain during activity? YES / NO
Medication for blood pressure, heart condition, or diabetes? YES / NO
Asthma (including exercise-induced)? YES / NO
Dizziness, fainting, or loss of consciousness? YES / NO
Bone/joint problems worsened by exercise? YES / NO
Any other reason you should not exercise? YES / NO

If YES to any: You must have GP clearance and confirm this below.
If all NO: You may participate, building gradually. Inform your instructor of any health changes.

ADDITIONAL SUPPORT

Do you have any condition or impairment requiring support? YES / NO

CONSENT & LIABILITY

I understand exercise involves risks (including injury or illness). I agree to:

• Exercise at a level suitable for me

• Stop if I feel pain, discomfort, or unwell

• Take full responsibility for my participation

I confirm I have answered honestly and (if required) have medical clearance.

Signature: _______________________Print Name: ______________________

Date: _______________

DATA PROTECTION Information is kept securely for safety purposes, not shared, and retained for up to 6 years.