Beruflich Dokumente
Kultur Dokumente
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Personal Details:
Gender:
Address: __________________________
Male Female
Suburb: ____________________
Name: ___________________ Postcode: ________
Surname: ________________
Phone: ____________________
Date of Birth: _____________ Mobil: ____________________
Email: ______________________________
Emergency Contact Name: _________________________
Emergency Contact Phone: ____________________
Occupation: ____________________
Medical History:
Tick the box or type yes if any of these statements apply to you:
Heart Conditions
Tightness in the chest
Family history of stroke
Liver / Kidney condition
Arthritis
Any major injuries
Epilepsy
Back pain
High/Low blood pressure
Chronic cough
Diabetes
Any infections disease
Asthma
Conditions limiting activity
Are you willing to travel to different suburbs in the west for Boot
Camp?
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Date:
__________________________
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Trainers Name:
Trainers Signature:
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