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Informed Consent and Agreement

I understand that the information provided on the health questionnaire is confidential. I am happy for my photo to be taken and used for advertising proposes across all media platforms. I am happy to be contacted by "ADAPT Health, Fitness and Education", "Staffs Lifting Club" or "Redefine Education" for marketing purposes. Any questions that I have about my participation have been answered to my satisfaction.
Having read the above I agree to participate in exercise and acknowledge the risk of injury that is associated with such activity. I accept full responsibility for my own health and wellbeing. I understand that if I fail to provide 24hours notice for a missed session I may be charged in full.

Your Goals

Please outline two short term goals (10wks) and two long goals (6-12months). This will be used to measure your progress and ensure that we are both working towards achieving these...

Health and Safety

For your health and safety please answer the following questions and inform your coach of any factors that might affect health during exercise. If there are any questions you do not understand please do not hesitate to ask.

You should not attend club sessions if you show any signs of the below

tickboxPersistent Cough

tickboxHigh Temperature

tickboxLoss of Taste

tickboxNo Signs or Symptoms

tickboxLess than once a month

tickboxOnce a month

tickboxOnce a week

tickboxTwo or three times a week

tickboxFour or five times a week

tickboxMore than five times a week


tickboxModerately Fit

tickboxTrained Highly Trained









tickboxHigh Blood Pressure



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