Fitness Belfast - sign up!

Thanks for your interest in working with me - just fill out some details below and we'll get started!

Your contact details
Your Name *
Your Name
If you are filling out this form having received a gift voucher, please put the gift voucher number here. If not, just leave blank.
About you & your health
YOU ARE KINDLY REMINDED NOT TO TAKE ANY EXERCISE BEYOND YOUR PERSONAL RANGE OF ABILITY, AS ADVISED BY THE INSTRUCTOR (ME, GARY), OR BY ANY RELEVANT MEDICAL PROFESSIONAL, AND THE INSTRUCTOR CANNOT BE HELD RESPONSIBLE FOR ANY HARM THAT MAY ARISE TO ANYONE WHO IGNORES THIS ADVICE.
Do you smoke? *
Do you suffer from asthma? *
Do you suffer from high or low blood pressure? *
Do you suffer from dizzy spells whilst exercising? *
Do you suffer from back problems? *
Do you suffer from joint problems? *
Do you suffer from excessive breathlessness whilst exercising? *
Do you suffer from chest pains? *
Are you pregnant, or have you given birth in the last 3 months? *
Have you suffered a serious illness in the last 18 months? *