Core Connections Screening Form

Thank you for booking onto the Core connections workshop – Both Sarah and I are looking forward to seeing you all.

The session will start at 14.30pm please arrive no later than 14.15pm to register.

Sarah will be on hand to individually assess abdominal tone and give preliminary advice before the session starts.

Wear comfortable clothes that you can move in as I will be taking the exercise session in the second half.

This will be the first time at the venue Kate Campbell fitness - we are located Below the Miller and Carter steak house pub on Ecclesall Road South. Parking is the bottom car park.  

Babies are welcome, mats and baby chairs available. Unfortunately we cannot accommodate pre-schoolers.

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.

Any questions please do not hesitate to contact Kate Campbell Fitness


Name *
Date of Birth
Date of Birth
Address *
Date baby born/due date *
Date baby born/due date
Waiver *
I hereby state that I have read understood and answered honestly the screening questionnaire. During the exercise programme, every effort is made to keep the class safe and minimise the risks whist 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 agree to participate in the exercise programme described to me by Kate Campbell and the Kate Campbell Fitness Team I understand that in order for the session to remain safe, alternatives and adaptations will be made throughout. The structure, purpose, benefits and risks of the session will be explained throughout the class, and I understand that I may withdraw from the session at any time. I will inform Kate or the KMF team instructors if any physical / Medical changes occur which may prevent me from exercising safely. If at any time you feel undue pain or excessive discomfort, Stop the activity and inform instructor. I understand that from time to time photographs will be taken for advertising and promotion, and i agree to have any pictures of me used in this way.