• Arthritis
• Asthma
• Cancer
• Diabetes
• Epilepsy
• High Blood Pressure
• High Cholesterol
• Osteoarthritis
• Osteoporosis
• Pacemaker
• Pregnant
• Recent Surgery
• Regular Smoker
• Thyroid Issues
• None of the above apply to me

• Has your doctor ever told you that you have a heart condition?
• Have you ever suffered a stroke?
• If you have Type I or Type II Diabetes, have you had trouble controlling your blood glucose in the last 3 months?
• Have you had an asthma attack requiring immediate medical attention at any time over the last 18 months?
• Do you ever experience unexplained pains in your chest when resting or during physical exercise/activity?
• Do you ever feel faint or have moments of dizziness during physical exercise/activity which causes you to lose balance?
• Do you have any undiagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical exercise/activity?
• Do you have any other medical conditions that may make it dangerous for you to participate in physical exercise/activity?
• None of the above apply to me

• Yoga
• CrossFit/Olympic Weightlifting
• Cycling
• Long distance running (5+km at a time)
• See a regular allied health professional (chiro, physio, massage, osteo)
• Vegan diet / plant based diet
• Eat grains regularly (wheat, barley, rye, corn, rice,etc)
• Regular coffee consumption (1+/day)
• Regular alcohol consumption (>1/week)
• None of the above apply to me

PREVIOUS INJURIES AND TREATMENT

CURRENT EXERCISE

REASONS FOR WANTING TO TRAIN WITH WCB?

SUCCESSFUL RESULT IN FIRST 3-6 MONTHS?

EMERGENCY CONTACT DETAILS

SOCIAL MEDIA AGREEMENT (1 ON 1 CLASSES)

• I consent to be in photos and videos in 1:1 classes for West Coast Biomechanics social media promotion.
• I do not consent to be in photo and video content created by West Coast Biomechanics used for social media promotion for 1:1 training.

SOCIAL MEDIA AGREEMENT (GROUP CLASSES)

By ticking the box below, you agree to be in photos and videos in group classes for West Coast Biomechanics social media promotion.

• I agree

CANCELLATION POLICY

WCB require a minimum of 24 hours’ notice if you wish to cancel or reschedule. Non-attendance to booked appointment, with no reasonable explanation, will attract a 100% charge. This policy ensures other clients can access services rather than being put on a waiting list or turned away. By signing below, you agree to abiding with the cancellation policy.

• I agree

PRIVACY POLICY

By ticking the box below, you acknowledge that you have read and understood the Privacy Policy and agree to the collection, use, and disclosure of your personal information as described herein.

• I agree

Everything I have provided in this waiver is true to the best of my knowledge as of the date signed below. Please type your full name below as your electronic signature.

Signature (Applicant)

Signature (Parent/Guardian) - Only required for applicants under 18 years of age.