Registration Form

Personal Details

Your Email Address(*)
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Password (6 or more letters & numbers only; case sensitive):(*)
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Confirm Password(*)
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First Name(*)
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Last Name(*)
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Gender(*)
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Date of Birth(*)
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Your Address(*)
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City(*)
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Country(*)
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Post Code(*)
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The Physical Activity Readiness Questionnaire (PAR-Q)

Have you been told that you have a heart condition and that you should only do physical activity recommended by a doctor?(*)
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Do you feel pain in your chest when you do physical activity?(*)
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In the past month, have you had chest pain when you were not doing physical activity?(*)
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Do you lose your balance because of dizziness or do you ever lose consciousness?(*)
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Do you have a bone or joint problem that could be made worse by a change in your physical activity?(*)
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Is your doctor currently prescribing drugs for your blood pressure or heart condition?(*)
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Do you know any reason why you should not do physical activity?(*)
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Medical History

Average blood pressure (if known):
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Do you have..?

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Do you have problems with..?

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Have you had a recent fracture?(*)
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If yes, when:
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Has your doctor imposed any activity restriction due to illness or injury?(*)
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If yes, please explain:
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Are you pregnant?(*)
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Family Medical History

Have your parents or your immediate family suffered from: (tick appropriately):

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Lifestyle History

Are you a cigarette smoker? If yes, how many per day:(*)
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Previously a cigarette smoker? If yes. when did you quit?(*)
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Please rate your daily stress level:(*)
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How many units of alcohol do you consume per week ?(*)
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Please provide a brief explanation of your eating habits:(*)
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Activity/Exercise History

Have you been exercising regularly over the past two years?(*)
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On average, how often do you exercise each week?(*)
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Other (please specify):
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On average, how long do you exercise per session?(*)
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On a scale 1 to 10, how intense is your typical workout?(*)
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Activity/Exercise Interests (please tick any activities in which you have an interest):

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Please tell us of any other Activity/Exercise Interests:
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Do you play any sport?(*)
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What is/are your sport(s)?
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At what level do you play sport?
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How experienced are you with (yearly planned) structured resistance training?(*)

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Your Training goals

Please be very specific and detail both your short-term and long-term goals:(tick or complete appropriately)

Sport Performance:(*)
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General fitness:(*)
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Lose body fat:(*)
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Look better:(*)
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Increase flexibility:(*)
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Reduce stress level:(*)
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Injury rehabilitation:(*)
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Other
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(*)
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Thank you for completing this registration form