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POWR FITNESS require the following information to ensure that all safety requirements are fulfilled whilst visiting and using the facility, for your own safety and to ensure we can service you better.

It is a requirement of entry that you complete the form below prior to commencing your exercise program.

Medical considerations:

It is our professional duty of care to ask all participants, no matter what age, to complete the following questions.

Any family member under 60 whom has suffered heart disease, stroke or raised cholesterol?
Are you on prescribed medication that may affect your ability to exercise?
Have you given birth within the last six weeks?
Are you pregnant?
Have you been hospitalised recently?
Do you, or have you ever had any of the following conditions (please check all that apply)

If you have answered yes, or are not sure to any of the above, please see your Doctor and ask for a medical certificate prior to commencement of any exercise program.

Have you ever had, or do you now have any pain or major injuries particularly in the following areas (please check all that apply)

Ask any gym staff member to guide you into the most suitable class or program. Work at a low level on your first visit and concentrate on learning to do the exercise properly. On each visit you will be able to work a little harder. Be sure to limit yourself to a pace where you can still talk comfortably.

Should you suffer any injury, illness or conditions in the future please tell us before you commence your program. It is recommended that all persons over 40 should have a medical assessment including an exercise ECG and cholesterol / lipid count by their doctor before starting a program.

Disclaimer: By submitting this form I recognise that the instructor is not able to provide me with advice with regards to my medical fitness and that this information is used as a guideline to the limitations of my ability to exercise. I have answered the questions to the best of my ability and understand the advice above.

Thanks for submitting!

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