Albany Park Baptist Church

Please fill in this form to register for Community Fitness. You will be required to complete a health and fitness questionnaire at the start of your first session.

Name (Required)

Email Address (Required)

Your Phone Number

Emergency Contact

In the event of an emergency, who do we contact? Phone number?

Thinking about the last 12 months, how often have you been on a run or a jog?

Daily/most days

Weekly

Twice a month

Monthly

Occasionally

Never

How many times have you exercised in the last week?

Do you suffer from any of the following?

Diabetes

Heart problems

Joint problems

High Blood Pressure

Asthma

Back pain

Previous injuries

None of the above

Do you have a long term illness, health problems or impairment?

If yes, which of these best describes how your impairment or illness affects you. Please select all that apply

Vision (blindness or visual impairment)

Hearing (deafness or hard of hearing)

Learning, concentrating or remembering

Wheelchair user

Dwarfism

Cerebral Palsy

Amputee

Mental Health Problems

Social or behavioural issues, for example, due to neurological diverse conditions such as Autism, ADD or Aspergers' Syndrome.

Other (including stamina or breathing difficulty, difficulty speaking or making yourself understood, dexterity difficulties or l

Declaration (by submitting this form you agree that you have read the declaraation (Required)

Community Fitness Group leaders are qualified leaders and are willing to share their experience and enjoyment of sport with me. I confirm that I understand that participation in this group is entirely at my own risk and should consult my doctor if suffering from any condition that might make running or exercise injurous to my health.

Albany Park Baptist Church

Stansted Crescent, Bexley
DA5 3JB

Links:

Calendar Where to find us Policies and Procedures