Waiver form *

By signing this waiver, I agree to the terms and conditions of Kfit.

Name *

Name

First Name

Last Name

Email Address *

Mobile Number *

Address Line *

Postcode or Zip *

State *

Gender *

Date of Birth *

Date of Birth

YYYY

Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke? *

If you answered yes, please provide details about your heart condition or stroke. *

Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise? *

If you answered yes, please provide details about your chest pains. *

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months? *

If you answered yes, please provide detail about your asthma attack

Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance? *

If you answered yes, please detail

Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise? *

If you answered yes, please provide details about this

Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise? *

Are you currently pregnant or given birth in the past 6 weeks? *

If yes, please detail

This screening tool does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use.

I undertand

This Screening system in no way guarantees against injury or death. *

I understand

No responsibility or liability whatsoever can be accepted by KFIT BY KM PTY LTD for any loss, damage or injury that may arise from any person acting on any statement or information contained in this tool. *

I understand

I believe that to the best of my Knowledge, all of the information I have supplied within this tool is correct. Parent/guardian to sign if under 16 years of age. *

I agree

We're always interested, how did you hear about Kfit? *

Waiver

Manditory Health check screening form

We value your privacy as much as you do. We will not be giving your details out to any other parties.