General Screening Form

The information collected in this form will be used only for the purpose of designing an appropriate fitness program for you and will not be disclosed to any third party without your consent.

We reserve the right to request a doctor’s clearance before allowing you to receive personal training with Kate Campbell Fitness.

Please fill out the form as thoroughly as possible.

Name *
Name
Address
Address
Date of birth *
Date of birth
Have you ever had any of the following? *
If yes please provide more detail in the comments box below
Informed consent *
I understood and answered all the above questions honestly During the exercise programme, every effort is made to keep the session safe and minimise the risks while providing an effective session. I am participating of my own free will and I am aware, as with any exercise programme there is a risk of injury I understand that it is my responsibility to inform KATE CAMPBELL FITNESS of any medical conditions I have that may affect my ability to exercise safely and to update this information as and when necessary. I understand that I should not exercise if I feel unwell The structure, purpose, benefits and risks of the session will be explained throughout, and I understand that I am FREE to withdraw from the session at any point. I will not hold KATE CAMPBELL FITNESS and her staff liable in any way for injuries that may occur while I am training.