Gym Membership Testing Entry Consent Form
Please complete this form to provide your information and consent for gym membership entry testing.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which gym location are you testing for?
*
Please Select
Downtown Gym
Uptown Fitness Center
Westside Gym
Other
Are you currently experiencing any of the following? (Check all that apply)
*
Fever or chills
Cough or sore throat
Shortness of breath
Recent injury or pain
None of the above
Other
Please list any medical conditions or medications that may impact your participation in gym activities.
How would you rate your current fitness level?
*
Beginner
Intermediate
Advanced
Other
Signature (Please sign to confirm your consent and agreement)
*
Submit Consent
Submit Consent
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