Sports Renew Registration Form

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Please complete this form to register your interest in participating in Sports Renew: from COVID to Comp.

Created by Donvale Netball Club in partnership with local fitness studio Recharge Plus and the Manningham City Council Community Grants Program, we are delighted to be able to offer this to participants for FREE!

PRIVACY DISCLAIMER: your details provided in this form remain private and are not passed on to a third party. Your health details are stored securely and privately by Recharge Plus to ensure your health and physical wellbeing is supported during sessions in Sports Renew.

Session times:
Pilates Advanced at 6pm-7pm Tuesdays starting 29th of September
Pilates Essentials at 11am-12pm Saturdays starting 3rd of October

The email address entered below will receive a Zoom link to participate each week.

if you are attending with another member of your household, please ensure they also fill out this form for their safety.

If you have any questions or concerns about this form, please contact Lucy Barker at lucyb0297@gmail.com

Email *

If you are joining Sports Renew through a local sports/community organisation, please indicate below *

Please name your organisation in 'other' if joining through a local sports.community organisation

I am not joining through a local sports/community organisation

Other:

Name *

Street Address

Phone number *

Date of birth *

YYYY

If participating in Advanced Pilates, please confirm you have a good level of strength and/or have attended a Pilates class in the past.

Yes

Clear selection

Have you experienced any of the following: *

High blood pressure

Heart condition or any Cardiovascular conditions

Unexplained pains in chest at rest or during exercise

Asthma requiring medical attention in the last 12 months

Suffered a stroke

History of coronary heart disease in your family

Do you suffer from high cholesterol

Major illness or surgery in the last 5 years

Dizziness, feel faint or blackouts during exercise

Have you had a hernia in the last 12 months

Epilepsy

Diabetic & having trouble controlling your blood glucose in the last 6 months

Are you pregnant/given birth in the last 8 weeks

Arthritis or other joint / muscular pain

None of the above

Required

Have you experienced any injuries in the following areas: *

Neck

Back

Ankles

Knees

Shoulders

Wrists

Elbows

Hips

None of the above

Other:

Required

If yes to any of the above, please give details. Please be advised you may need to seek medical clearance before attending classes

Do you have any other medical condition(s) that may make it dangerous for you or affect your ability to participate in an exercise program with us? If yes, please provide details below.

Are you on any medication? *

Yes, this may affect my participation in the class

Yes, but it will not affect my participation in the class

Are you doing regular exercise at the moment?

Yes

Sometimes

Clear selection

Please describe your current exercise regime.

How would you describe your overall current state of health?

What do you want to achieve by attending Sports Renew?

Please include your main goal and your reason for wanting to achieve that goal.

Waiver *

I acknowledge I have been taken through the above induction and agree that all information provided is true and correct. I acknowledge that I will not have any claim or action of any kind against Recharge Plus for any illness, injury or adverse change in medical condition or state of health arising directly or indirectly from any exercise program or services I undertake at Recharge Plus, both in the studio and via remote training.

I agree

Required

Submit

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