top of page
Image by Meghan Holmes


Health Declaration

Health Declaration

Please fill out the questionnaire below and send it to us once you've signed it!

We look forward to seeing you on the day!


Health Declaration

Please fill out the following form
in order to participate in our activity.

Has your doctor ever said that you have a heart condition?
Is your doctor currently prescribing you medication for a health conditon?
Have you ever been told you should only perform physical activity when recommended by a doctor?
Do you feel pain in your chest when performing physical activity?
Have you ever experienced chest pain in the last month when NOT performing physical exercise?
Do you lose your balance because of dizziness or have you lost consciousness recently?
Do you suffer from high/low blood presure?
Do you have any joint or bone problems (back, knee, hip, etc) such as arthritis which could be aggravated through physical exercise?

Thanks for submitting!

bottom of page