Fitness Class Registration

Full Name

This address will receive a confirmation email

Phone

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Yes No

Do you feel pain in your chest when you perform physical activity?

Yes No

In the past month, have you had chest pain when you were not performing any physical activity?

Yes No

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes No

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

Yes No

Do you know of any other reason why you should not engage in physical activity?

Yes No

If you have answered YES to one or more of the above questions, consult your physician before engaging in physical activity. Tell your physician which questions you answered YES to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition.

By submitting this registration, I agree not to hold The Chosen Vessel Church, the board, employees, leaders, volunteers, and representatives harmless in the event of accident or injury while participating in fitness class and activities at The Chosen Vessel Church.

I have obtained the necessary clearance, if needed, from my doctor to participate in the fitness classes. I understand that participating as it relates to all events and activities, I hereby assume all risks of and claims associated with any such illness or injury.

Fitness Class Registration

Description

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