Programs & Challenges

BOOTCAMP!

First Name

Last Name

Date of Birth

Mobile Phone

Are You a Y member ? ( Yes/No)

Emergency Contact Name:

Emergency Contact Phone:

Do you have any injuries/illnesses that our trainers need to be aware of?

Pre-Exercise Screening

Please check the box to answer "YES"

Has your medical practioner ever told you that you have a heart condition or have you ever suffered a stroke?

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

Do you ever feel faint, dizzy or lose balance during physical activity/exercise?

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?

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