Full Name *Phone Number *Email Address *Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance? *Please select an optionNoYesIf you have diabetes (type I or type II) have you had trouble controlling your glucose in the past 3 months? *Please select an optionNoYesDo you ever experience unexplained pains in your chest at rest or during physical activity/exercise? *Please select an optionNoYesHave you had an asthma attack requiring immediate medical attention at any time over the past 12 months? *Please select an optionNoYesDo you have any diagnosed muscle or joint problems that could be made worse by participating in physical activity/exercise? *Please select an optionNoYesDo you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise? *Please select an optionNoYesIf answered "Yes" Please Elaborate;Emergency Contact Full Name *Emergency Contact Number *GDPR *By ticking this box I agree I have answered all the fields above honestly and as correct as possible. I understand and agree with the privacy policy and terms and conditions of Westgate Health Club. If I have answered "YES" to any of the above questions I have seeked or will seek approval from a qualified GP or appropriate specialist before commencing any activities within the of Westgate Health Club Facility. Signature *Send Message