Term/Session details:
Location:	Riverstone Sports Centre - Riverstone , Sunday : 5PM-7PM Riverstone Sports Centre - Riverstone , Saturday : 5PM-7PM Sydney Sports Club - Kings Park , Sunday : 2PM-4PM
Surname:
First name(s):
Title:	Select Mr Mrs Miss Master
M/F?	Select Male Female
Date of Birth:
Home address:
Telephone (Home):
Telephone (Mobile):
Parent/Guardian Name:
Emergency Contact Number:
E-mail:
Ethnic origin:
Doctor ever said that you have a heart condition?	Select Yes No
Experience chest pain during physical activity?	Select Yes No
Experience chest pain during inactivity?	Select Yes No
Taking medication?	Select Yes No
Medications (if any):
Pregnant or had a baby in the last 6 months?	Select Yes No
Other reasons not to participate in physical activity?	Select Yes No
Physical or intellectual disability?	Select Yes No
I have read, understood, and completed the information requested above