New Waves Walk to Run Application Form
All details are private, confidential and not shared to any third parties. We require your email address so that you can receive a copy of your application form.
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Email *
Which group would you like to join? *
Required
Name *
Phone number *
I am over 18 *
Emergency Contact
Name *
Relationship to you
Phone number(s) *
Health Information
Are you currently, or have you ever been affected by any of the following: *
Required
If you have ticked any of the above, please give details and dates
Are you pregnant or have you given birth in the last 6 months? *
Are you taking any medication? (please state the names of medication)
How would you rate your current general fitness on a scale of 1-10?
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Please list any physical activities that you currently participate in?
What has put you off running in the past?
How do you envisage this programme will benefit your life?
What are the potential barriers that could get in the way of completing this programme if any?
What size are you? (this is for your free Walk to Run t-shirt) *
Are you happy to be added to the New Waves Newsletter?
Clear selection
Disclaimer
In submitting this form I confirm that I have read its contents in their entirety and that my answers to the health questions are true and accurate. I believe that I am able to participate safely in any exercise activity during group or personal training sessions.

Should my medical condition change after submitting this form, I will inform Louise at New Waves prior to commencing any further exercise activity. I understand that I am responsible for monitoring myself throughout any exercise activity, and should any unusual symptoms occur, I will cease participation immediately.
I understand that any type of fitness session can be a strenuous form of physical activity, and that I may be exposed to risk of injury. I am fully aware of those risks which include (without limitation) possible injuries to my muscles, bones, joints and tissue.

I also understand that there exists the possibility of adverse changes during any exercise activity undertaking during fitness sessions including (without limitation) abnormal blood pressure, injury, fainting, disorder or heart rhythm, stroke, and in rare instances, heart attack or even death.
Notwithstanding the above, I choose to participate knowingly, voluntarily, of my own accord.

I fully understand that any exercise instruction and advice given is in no way intended as a substitute for medical consultation.

In the event that medical clearance must be obtained prior to my participation in any group or personal training session, I agree to contact my GP and obtain written permission prior to the commencement of the session and any exercise activity.

All client information will be held in a private and secure computer database and/or lockable filing cabinet for a period of up to 10 years. The client’s information will not be shared to any third party unless compelled to by law.
Finally, you understand that New Waves, will at times, capture photographic and video footage during sessions which may be used for promotional material. You consent to any footage captured in sessions to be shared via social media but understand that you have the right to opt out of being included in such material and can contact Louise at New Waves to request this action.

By submitting this form I am accepting this disclaimer and hereby release and forever discharge from any claims and liabilities whatsoever without limitation that I might have against New Waves, Louise, or any of the coaches/instructors working for or in collaboration with New Waves and I make this release on behalf of myself, my heirs, executors and administrators.
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