STRONG HOLD ACADEMY
Personal details of the person training
Choose the program
*
CLICK TO SELECT YOGA PROGRAM ...
Yoga Drop In ( £15.00 p/m )
Hot Yoga Intro ( £30.00 p/m )
5 Class Pass ( £50.00 p/m )
10 Class Pass ( £100.00 p/m )
Personal Details
Title
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Mr
Mrs
Miss
Ms
First name
*
Last name
*
DOB
*
Email
*
Mobile
*
Landline
Address
PostCode
*
Line 1
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Line 2
Line 3
Town/City
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County
Country
*
United Kingdom
Emergency contact details, if different from the above
Title
Select title ...
Mr
Mrs
Miss
Ms
First name
Last name
Relationship
Contact number
Email addrees
Medical conditions (if applicable)
Tick YES on the medical condition that applies to you
By default, it is assumed that you do not have any medical conditions.
YES or NO
Has your doctor ever told you that you have a heart condition and should only do physical activity recommended by a doctor?
YES
NO
Do you feel pain in your chest when you do physical activity?
YES
NO
In the past month, have you had chest pain when you were doing physical activity?
YES
NO
Do you ever lose your balance because of dizziness or lose consciousness?
YES
NO
Do you have a bone / joint problem that could be made worse by physical activity?
YES
NO
Is your doctor currently prescribing drugs for any blood pressure/heart condition?
YES
NO
Do you have any learning difficulties?
YES
NO
Have you ever been convicted for Violence?
YES
NO
Is there any health reason that may affect your training?
YES
NO
Enter any other medical or disability