Strength & Co – Free Trial Health Screening & Consent

Name: {name}
Date of birth:
Emergency contact name and phone:

Consent to use health information

I explicitly consent to STRENGTH&CO. LIMITED storing and using the health information I provide to assess whether training is suitable and plan safe exercise. This information is held in Gymdesk and relevant email correspondence, with access within Strength & Co restricted to Mark Cousins.

I can withdraw this consent at any time by emailing info@strengthandco.co.uk. If information necessary for safe coaching is unavailable, we will discuss whether suitable training can continue.

This consent is separate from consent to exercise and does not include marketing.

Health screening
Answer YES or NO to every question. A YES does not automatically prevent participation; discuss it with your coach before exercising.

1. Has a doctor advised you not to exercise, or do you have a condition affecting safe exercise?

2. Do you have a heart condition, high blood pressure, chest pain, dizziness/fainting, or a breathing condition that exercise may worsen?

3. Have you had surgery, hospital treatment or a significant illness in the last 12 months?

4. Do you have an injury, pain, joint/back problem or other physical limitation?

5. Do you take medication that may affect exercise safety?

6. Are you pregnant, or have you given birth in the last six months?

7. Is there any other reason exercise may be unsuitable, or anything your coach should know?

For any YES, give the question number and relevant details or limitations. Otherwise write NONE:

Declaration and informed consent
I confirm my answers are accurate and complete to the best of my knowledge. I will tell my coach about any YES answers before training and any changes to my health. My session may need adapting or postponing while further information or appropriate medical advice is obtained.

I understand that strength, resistance and cardiovascular exercise involve risks, including strains, falls and occasionally serious injury. I voluntarily consent to participate, having had the opportunity to ask questions. I will follow coaching and equipment instructions, exercise within my ability, and stop and tell the coach immediately if I develop pain, dizziness, chest discomfort or feel unwell. I may stop participating at any time.

This form does not exclude or restrict liability for death or personal injury caused by negligence, or any other liability that cannot lawfully be excluded.

This booking is for one free trial, with no commitment to paid membership. Please cancel at least 12 hours before the session.

By signing, I confirm I have read and understood this form and consent to participate.
Signed by:
Date: {sign_date}