Pre-exercise registration survey

Newly-registered participants for Council recreation programs must complete this registration survey prior to their first class.

e.g. 1/1/1970
Select the exercise program(s) you* - required
Personal health history
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?* - required
2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?* - required
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?* - required
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?* - required
5. If you have diabetes (Type I or Type II) have you had trouble controlling your blood glucose in the last 3 months?* - required
6. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?* - required
7. Have you had any recent operations or injuries?* - required

If you answered YES to any of the first 6 questions under "personal health history", please seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/exercise.

Mandatory field(s) marked with *

Important: This survey is self-evaluated. It does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Council for any loss, damage or injury that may arise from any person acting on any statement or information contained in this survey.

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Page last updated: 24 Mar 2022