Staffs Lifting Club PARQ Kids

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.

Childs Name

DOB

Age

Parent / Guardians Name

Parent / Guardians Mobile

Parent / Guardians Name Email

Why do you want to join Staffs Lifting Club, goals and ambitions etc:

Goals

For your child's health and safety please answer the following questions and inform the 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 does your child 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

Does your child have any weightlifting experience?

Yes

How would you describe your present level of fitness of your child?

Unfit

Moderately Fit

Trained Highly Trained

Do you, your child or anyone in your immediate family, suffered from any form of heart condition?

Yes

Does your child ever feel any chest pain when you exercise?

Yes

Does your child ever feel dizzy, light headed, or suffer palpitations when you exercise?

Yes

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

Is your child currently taking any form of medication?

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

Does your child have any form of muscle, bone, or joint injury?

Does your child have any specific dietary requirements e.g. diabetes, vegetarian or celiac?

Are there any other medical conditions or health related information that you feel the coaches sho

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact number:

 info@staffsliftingclub.co.uk

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