Pre Exercise Screening Questionnaire

Matrix Boxing Gym Inc./Axis Gold Coast

    Staff Notes

    Personal Details

    All fields are required.

    Emergency Contact

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    Extra Details

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    YesNo


    YesNo


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    Yes

    Declaration

    I warrant as fundamental condition of my being allowed entry to the 'No Excuses Training Centre/Matrix Boxing Gym Inc./AXIS Gold Coast’ facility that I am

    1. Medically able to participate in physical exercise and use the facilities; and
    2. not aware of having and physical or mental disability, condition or disease which might be aggravated or worsened by physical exercise or which could result in the deterioration of my health if physical exercise is undertaken and:

    understand that 'No Excuses Training Centre/Matrix Boxing Gym Inc./AXIS Gold Coast’ its managers contractors and staff are not able to provide me with medical advice.

    I;

    1. agree to seek my own medical advice from a qualified medical professional prior to undertaking any activities and will not hold 'No Excuses Training Centre/Matrix Boxing Gym Inc./AXIS Gold Coast' its’ managers contractors and staff liable in any way for any injuries to me

    Any questions I had were answered to my full satisfaction.

    1. am aware and accept that with any physical activity, including the activities offered at 'No Excuses Training Centre/Matrix Boxing Gym Inc./AXIS Gold Coast' there is a risk of either minor or major accidents, illness, sickness, injury or death occurring.
    2. acknowledge that use of 'No Excuses Training Centre/Matrix Boxing Gym Inc./AXIS Gold Coast' and its facilities are at my own risk.
    3. confirm having read, signed and agreed to 'No Excuses Training Centre/Matrix Boxing Gym Inc./AXIS Gold Coast' “conditions of entry.”




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