Register

First name *

Surname *

Gender *

Male

Female

Date of birth *

Day

Month

Year

Address *

Suburb *

Postcode *

State *

Company name/employer

Occupation

Which location will you attend? *

Rhodes Mill Park

Chiswick - Wire Mill Park (adjacent to Chiswick Community Centre )

Email *

How will we contact you?

Contact number *

Emergency contact name *

Emergency contact number *

As part of our duty of care, it is a requirement to ask all participants, no matter what age, to complete the following questions.

Has a family member (under 60), suffered from heart disease, stroke, raised cholesterol or sudden death? *

Yes

No

Are you a male over 35, or a female over 45 and not used to regular exercise? *

Yes

No

Have you been hospitalised recently? *

Yes

No

Are you pregnant? *

Yes

No

Have you given birth in the last 6 weeks? *

Yes

No

Are you on any prescribed medication? *

Yes

No

Do you have any heart conditions? *

Yes

No

Do you have high blood pressure (>149/90)? *

Yes

No

Do you have, or have you ever had? *

Other (please specify)

Do you have any pain or major injuries in the following areas? *

Participants self clearance *

Acknowledgement: The City of Canada Bay outdoor group fitness sessions are designed for all levels, and we welcome all shapes, sizes and ages (18+) in the community. If you have ticked any of the above, are in poor health, or have a pre-existing medical condition, we strongly recommend you consult your general practitioner before beginning a new fitness program. You acknowledge that, by participating in these sessions, you are doing so voluntarily and, depending on your particular circumstances, there may be risks to your health. You are responsible to make your own enquiries and seek independent advice from a healthcare professional before acting on any information or material made available.

I warrant that I am physically and mentally well enough to proceed with the City of Canada Bay's 'Free Outdoor Fitness Sessions'

Participants self clearance *

I accept this 'Participants Self Clearance' for any previously acknowledged medical conditions during this registration

Tell us about yourself, and your activities: The measurements you give us need to be accurate. please measure yourself to obtain this information. This will help form the basis of your personal information and will effect the advice and assistance we give you.

Height * cm

Weight * kg

Waist circumference cm

How many times a week do you exercise? *

How active are you during your daily life? *

How active are you during your leisure time? *

Do you follow a special diet? *

Do you smoke? *

If you have any dietary issues or concerns, please consult your doctor before following any new nutrition plan

I'm looking to achieve:

Personal health and fitness goals

Losing some weight and toning up

Improve overall health and fitness

Improve overall strength

Socialise with others and relaxation

Frequently asked questions *

Frequently asked questions - please review the City of Canada Bay's FAQ's for participation in the the program

The City of Canada Bay FREE outdoor fitness program is designed for adults aged 18+ years. I confirm I am 18+ years or older

Frequently asked questions *

I accept the City of Canada Bay is providing the opportunity to participate in group training classes, and that I should consult my GP before taking part/or booking in to any sessions.

I would like to receive news updated from Canada Bay Active

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