Registration Form for Impact Fitness Bootcamp

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Book your place

Book your place on Bootcamp in Moira, Lisburn or Lurgan or Maghaberry by completing this Registration Form

You can find the locations of the bootcamps here and the dates and times here

Please complete the form and then press submit. All questions must be answered.

Surname: *

Location:

Lurgan Park at Waves Lisburn Racquets Club Moira Methodist Church Hall Maghaberry Primary School

Start date :

Mon 12th Mar (Lurgan & Maghaberry) Tue 13th Mar (Lisburn & Moira)

First name: *

Is this your first camp:

Yes No

Promotional Offer Code:

Home address: *

Post Code: *

e-mail address: *

Date of Birth: *

Home Town/City: *

Home telephone: *

Emergency Contact Number: *

Mobile Number: *

Emergency contact name: *

Fitness Level:

low average good

How did you hear about bootcamp: *

T shirt size:

small medium large xlarge

Now complete this physical activity readiness questionnaire.

If you are 15 to 69 the questionnaire will tell you if you should check with your doctor before you start. If you are over 69 and not used to being very active you should check with your doctor anyway.

Common sense is your best guide when answering the questions - please answer yes or no honestly. All YES answers require a written explanation at the bottom of the page.

Have you ever had any heart conditions:

yes no

Has a doctor ever said you should only do physical activity under a doctors recommendation:

yes no

Do you ever feel pain in your chest when physically active:

yes no

In the last 3 months have you had chest pain when you were not doing physical activity:

yes no

Do you lose your balance because of dizziness or do you ever lose consciousness:

yes no

Do you have bone or joint problems?:

yes no

Are you currently taking any medication for blood pressure or heart problems?:

yes no

Are you currently pregnant?:

yes no

Have you had a baby in the last three months?:

yes no

Is there any other reason why you should not start physical activity?:

yes no

Please explain all YES answers:

If you have answered yes to any of the health questions you must seek your doctors advice before starting bootcamp.

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