Phy
ysicall Activ
vity Readin
R ness Quest
Q tionna
aire
YOU
UR DETAILS
S EMERGENCY
E Y CONTACT
T DETAILS

Name
e …………………………………
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…. If you are involv
ved in an accide
ent, give detaills of who shou
uld we
coontact and howw.
Posta
al Address ……
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Na
ame……………
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el No…………… ……………………………………
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Day Tel
T No. …………
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Na
ame……………
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Even
ning tel No. ……
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Te
el No…………… ……………………………………
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Emaiil …………………………………
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ALTH AND SAFETY

HEA S ISS
SUES

Do yoou have a histo

ory of any of th
he Joint problem
ms……………… …………….. Do yo
ou smoke?
follow
wing? ………… …………………Y Yes/No Epilepsy…… …………………… ……………..
Do yo
ou have any dis
sabilities?
(Ple
ease tick box) Back compla aints…………… ……………..
Back compla aints…………… …………….. If yes,, please include details
Hearrt problems…… …………………
Are you on any
a sort of med
dication?..
Faintting spells……………………. ………
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Pain in chest while exercising… Any other significant illnes sses or ………
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High//low blood pre
essure……….. .recent opera
ations?............................... ………
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Breathing problems s/asthma…... ………
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Are you overr 40?...................................

CROOSSFIT-SPEC
CIFIC RHABDOM
MYOLYSIS Ap
part dediication and harrd work to THE SAFE
ETY OF
SAFETY/SPORTSS from norma al sporting inurries, masster the work-outs and EQUIPME
ENT/VENUEYOOU
INJU
URIES high intensiity exercising can
c obtaain elite performmance if ARE GOIN
NG TO USE
One of the many differences run the risk
k of a conditionn you are a beginnerr, start off Whatever piece
p of equipmment
called Rhabbdomyolysis. ForF by understanding,
u then
betwween normal gy ym fitness you intend to use should be
and Crossfit
C is your exposure more informmation on this praccticing the mov ves, then checked by y you: Collars
to injjury. At a basicc level, injury speakk to the trainerrs. lightt versions of thhe posted should be on
o Olympic ba ars,
Or follow; work kouts. If you trreat the
Crosssfit combines various Be aware of
o others aroun nd
Olymmpic sports in it’s work work k-outs with arrrogant you while you
y are training g and
www.sports sinjurybulletin..com conttempt and just jump in,
outs:: Whilst attemtting to /archive/rha
abdomyolysis.h html. while otherrs are training.
reduc ce the risk of accidents,
a theyy will get their revenge.
r So
sportting injuries arre accepted www.physs sportsmed.com
m/iss visitt the “how to start page” REMEMBER THE MAG
GIC
as a fact of life to athletes,
a ues/2004/04
404/brown.htm on the Crossfit ma ain site TOP!
WORD: ST
footbballers, climberrs, rugby www w.crossfit.com//cf- If you are not
n sure, or
LEAVE YO
OUR EGO AT info//start-how.htmml something has happened d that
playeers, boxers, we eight lifters,
etc. If you do not wish
w to your THE DOOR
R seems uns safe – STOP.
risk of
o injury do no ot follow Crossfit is about
a developiing
cross sfit. elite fitness
s, it requires

I declare tha
at all the inforrmation I have
e supplied is
s correct, and
d that I have read and unde
erstood the above
a advice.

Signed………
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…….. Da
ate……………………………………………