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Health At The Hut Project 

Registration Form

Personal Details













Please enter "N/A" if yo don't have an email address





Depends on "Ethnicity Group"



Please enter the total number of MINUTES

Under each heading, please select that best describes your health TODAY.






Please enter a number on a scale of 0 - 100


Please give an emergency contact name and number. This information will ONLY be used in an emergency



For most people, physical activity is very safe. The questions below have been designed to identify whether you should check with your doctor before starting activity. Please read the questions carefully & answer each one honestly. Tick YES or NO.








Please advise the instructor if you have any conditions that you might feel they might need to know of e.g. epilepsy, pregnancy (now or in the last 6 months) etc. Please note: If your health changes so that you would answer YES to any of the above questions, notify the Health At The Hut Coordinators and seek further advice from your GP.

Declaration

I understand that if I have answered 'YES' to one or more of the questions above, and the information is not detailed on my referral form, I may be asked to seek medical advice before attending the programme. I agree to notify the Health At The Hut Coordinators in writing of any changes to my health or medications and I understand that I participate at my own risk.
I understand that if I am not feeling well because of a temporary illness such as a cold or if I may be pregnant, I should talk to my doctor before starting or continuing with my exercise programme. I have read and understood this questionnaire. Any questions I had were answered to my full satisfaction.
Consent
If this form is for a child between the age of 4 & 16, a Parent/Guardian Consent form should be completed in addition to registration form.