Coach Profiles | ADAPT Health, Fitness and Education

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...

Goals

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.

Have you, anybody from your household or social bubble shown signs of COVID within 2 weeks

Persistent Cough

High Temperature

Loss of Taste

No Signs or Symptoms

How often do you normally undertake vigorous physical activity?

Less than once a month

Once a month

Once a week

Two or three times a week

Four or five times a week

More than five times a week

How would you describe your present level of fitness?

Unfit

Moderately Fit

Trained Highly Trained

Do you, or have you ever, suffered from any form of heart condition?

Yes

Do you ever feel any chest pain when you exercise?

Yes

Do you, or have you ever, suffered from any of the following?

Asthma

Diabetes

Bronchitis

Epilepsy

High Blood Pressure

Do you ever feel dizzy, light headed, or suffer palpitations when you exercise?

Yes

Have you had to consult your doctor in the last three months?

Are you currently taking any form of medication?

Have you suffered any form of viral or bacterial infection in the last two weeks?

Do you have any form of muscle, bone, or joint injury?

Do you have any specific dietary requirements e.g. diabetes, vegetarian or celiac?

Informed Consent and Agreement

Your Goals

Health and Safety