Personal Details & Training Information

We are thrilled to welcome you to the West End Strength community! Before diving into the gym, please complete the form below. It helps us to ensure you have the best experience. If you have any questions, feel free to ask—we’re here to help.

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PERSONAL DETAILS

Name *

First

Last

Date of Birth *

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Email *

Occupation *

Mobile Number *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

EMERGENCY CONTACT

Name *

Mobile Number *

Relationship *

MEDICAL INFORMATION

Has your doctor ever told you that you have a heart condition, or have you ever suffered a stroke or heart attack? *

• Yes
• No

Do you ever experience unexplained chest pains at rest or during physical activity/exercise? *

• Yes
• No

Do you ever feel faint, experience dizziness, shortness of breath or lose of balance during physical activity/exercise? *

• Yes
• No

Do you have any of the following conditions? Select all that apply. *

• Asthma
• High Blood Pressure
• Diabetes
• None of the above

Do you have any muscle, bone or joint problems or soreness that could be made worse by participating in physical activity/exercise? *

• Yes
• No

If yes, please provide details:

Do you have any other medical condition(s) or injury that would prevent you from exercising? *

• Yes
• No

If yes, please provide details:

Are you currently taking any medications? *

• Yes
• No

If yes, please provide details

Are you pregnant or have you given birth within the last 12 months? *

• Yes
• No

If yes, please provide details

Do you smoke cigarettes or have quit smoking in the last six months? *

• Yes
• No

If yes, please provide details

In submitting this medical history form, *

• I acknowledge and accept full responsibility for the accuracy and completeness of the information provided, understanding that any decisions made based on this information are at my own risk.
• I understand that it is my responsibility to promptly inform the gym of any changes to my medical fitness or health status, and I accept all associated risks arising from any failure to do so.

CURRENT EXERCISE & HISTORY

Are you currently excercising? *

• Yes
• No

What type of activities do you participate in?

How many sessions per week?One to TwoThree to FourFive +

How long are these sessions?Less than 30 minutes30 minutes +One Hour +

What is the intensity of these sessions?Easy/LightModerateHigh Intensity/Hard

If not currently exercising, please provide details on types of training you have previously participated in.

What is your primary reasons for seeking to engage in exercise?

MARKETING & COMMUNICATIONS

How did you hear about us? *

• Friend/Family
• Social Media
• Google
• Other

Name of Friend/Family

Please let us know how you found out about us

Email Communications *

• By completing this form, you agree to receive West End Strength community updates through email.

SIGNATURE

Date *

Submit