Health Information

Your safety is our highest priority. Please fill in the below to ascertain if you will require medical clearance before participating.

Participant First Name

Participant Last Name

Participant's Birthday

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

Yes

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

Yes

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

Yes

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

Yes

5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?

Yes

Not Applicable

6. 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?

Yes

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

Yes

Please outline any health concerns that we should be aware of:

I declare that the information I’ve provided is accurate & complete

If you answered ‘YES’ to any of the 7 questions, please seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/exercise.

If you answered ‘NO’ to all of the 7 questions, you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.

RELEASE / WAIVER AGREEMENT

I, being fully aware that the training being taught at Guardian Defence is a sometimes strenuous and body-contact activity, do hereby, myself, my heirs, or whomever I may be legal guardian of, waive, release, and forever discharge any and all rights and claims for damages which may result while training with any representatives, instructors, or members of Guardian Defence.

I also waive, release and forever discharge Guardian Defence, its agents, instructors and members from any and all rights and claims for damages concerning the use of any equipment in their training facility. Furthermore, I recognise AJ Kearns and Zunami White are Directors of Guardian Defence and do hereby waive, release and forever discharge any and all claims for damages, personal or otherwise, against them or their family.

I agree to pay the cost of and authorise Guardian Defence to take all steps it considers reasonably necessary to ensure the protection of my, or my child's welfare in the event of personal injury, including but not limited to the administration of any emergency medical treatment and ambulance transportation.

The Participant (or their Parent/Guardian) acknowledges that the Participant does not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent the Participant from participating in the above mentioned activity. If required, the Participant will obtain a medical examination and clearance.

I agree to the release/waiver agreement

Yes

I agree to the terms & conditionsView terms of use

Signature

Name of Person Completing Form

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