Please fill out the following before attending our Female Fighters Camp 2019
Camp Attendee Name
Date Of Birth
Address
Postcode
Your Email
Phone
Emergency Contact Name
Emergency Contact Email
Emergency Contact Phone
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor? YesNo
Do you feel pain in your chest when you perform physical activity? YesNo
Do you lose your balance because of dizziness or do you ever lose consciousness? YesNo
Do you have a bone or joint problem that could be made worse by a change in your physical activity? YesNo
Do you suffer from asthma, or breathing difficulties? YesNo
Do you suffer from diabetes or epilepsy? YesNo
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? YesNo
Do you know of any other reason why you should not do physical activity? YesNo
Have you ever had any injuries or chronic pain? (If YES, please explain.) YesNo If yes:
Have you ever had any surgeries? (If YES, please explain.) YesNo If yes:
Has a medical doctor ever diagnosed you with a chronic disease, such as heart disease, hypertension, high cholesterol, or diabetes? (If YES, please explain.) YesNo If yes:
Are you currently taking any medication? (If YES, please explain.) YesNo If yes:
Please inform us if there are any disabilities we need to know about. Including any learning disabilities, neurological conditions, hearing or vision impairments. Also if there are any reasonable adjustments we can implement to help your camp be enjoyable :
If you have answered YES to one or more of the above questions, consult your physician before engaging in physical activity. Tell you 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 attending the camp you agree that you have sort advice or accept liability in relation to anything mentioned above.
By submitting this form you are confirming that you have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.
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First Name
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