Casual Visitor Form PERSONAL INFORMATION Name* Address* Phone* Mobile* Gender* Email* Date of Birth* Occupation* Emergency Contact* Emergency Number* How did you hear about CFEA?* Friend / FamilyFacebookGoogle / Search EngineOnline SalesOther Please select one age category* Kids 5-11Teens 12-17Adult 18+ Which location is most convenient for you?* EllerslieHowick Do you have any previous CrossFit experience?* Yes No please provide details for how long and at which facility.* HEALTH ASSESSMENT Have you ever had any form of heart disease?* YesNo Have you ever experienced shortness of breath or chest pains?* YesNo Do you have a family history of heart disease?* YesNo Do you have high blood pressure?* YesNo Do you have diabetes?* YesNo Do you have any allergies?* YesNo Are you currently taking any medication?* YesNo Are you a smoker?* YesNo Do you ever get dizzy?* YesNo Are you currently exercising?* YesNo Have you participated in strenuous exercise before?* YesNo Are there any exercises that you know you cannot do?* YesNo Is there any reason you know of that you should not participate in exercise?* YesNo Do you have any current injuries?* YesNo Do you have problems with your knees?* YesNo Do you have problems with your back?* YesNo Do you have any hip/pelvis problems?* YesNo Do you have any neck / shoulder problems?* YesNo If you answered yes to any of the questions above please provide detailed information below Are there any other relevant medical details or other factors that we should be aware of? You are welcome to include feedback or suggestions also below WARNING … Safety first! High intensity exercise must be approached with caution in particular at the beginning. A gradual ramp-up of intensity is necessary to allow muscles cells to adapt to the new demands being placed on them. Failure to do increases the risk of a life threatening condition known as ‘Rhabdomyolysis’. In short the muscle cells are damaged flooding the bloodstream with toxins that can overwhelm the kidneys as they attempt to cleanse the blood, leading to potential shutdown. CrossFit can cause Rhabdomyolysis. It is important that you start at a reduced intensity. Brown urine, complete muscle weakness and/or swelling of joints are warning signs of ‘Rhabdo’. If you develop these symptoms, seek medical assistance IMMEDIATELY. Waiver & Release Liability