Learner Registration Form

Complete and submit our registration form

Certain fields are required, please fill in as much of the form as possible.
Your Information
 
Your gender is required
 
Fitness Declaration and Safety Agreement
History of heart problems This field is required
Epilepsy, seizures etc This field is required
Back problems This field is required
Joint problems This field is required
Asthma, breathing or lung problems This field is required
High blood pressure This field is required
Recent surgery This field is required
Learning difficulties This field is required
Physical disabilities This field is required
Language difficulties This field is required
If yes to any of the above, enter details.
 
Person to contact in case of emergency
 
Payment
 
Declaration
I declare to the best of my knowledge that I know of no reason why I should not participate in Exercise classes. I acknowledge that there are risks inherent in physical exercise. I agree to abide by the verbal or written instructions given to me by the Tutor and will observe any written notices regarding safety whilst training.
Declaration must be confirmed
 
 
  YMCA Approved and REPs Recognised
YMCA Awards