Senior Membership Registration First Name * Last Name * Email * Phone * Gender MaleFemale Date of Birth * Address Street Address Line 1 Steet Address Line 2 City Postal / Zip Code 0.00 Emergency Contact First Name * Last Name * Phone * Identification Verifcation Identification Card / Passport * Maximum file size: 512 MB Health Questionnaire Do you have any existing medical conditions? * Yes Noe.g. Heart Disease, diabetes, hypertensions etc. Medical Conditions Are you taking any medication that might affect your ability to exercise? * Yes No Medication List If they impact exercise Do you have any mobility or balance issues that we should be aware of? * Yes No Balance Issues Do you experience shortness of breath, chest pain, or dizziness during physical activity? * Yes No Cardiovascular and Respiratory Do you have joint or bone related issues that limit physical activites? * Yes No Musculoskeletal Health Have you ever been told that you should only do physical activity recommended by a doctor? * Yes No Doctor Recommended Activity Only Do you know of any other reason why you should not do physical activity? * Yes No Any Other Reason 0.00 Terms and Conditions * By submitting this form you are consenting to Body U FIT Health-Club's Terms and conditions. Submit
