Sport Ireland Campus Fitness
Registration Form for the Sport Ireland Campus Fitness Transform Programme, 17th January to 15th February 2022.

All data provided will be treated confidentially and according to Sport Ireland Campus privacy policy.
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Transform 2022 Group Choice *
Candidates Full Name *
Candidates Mobile Phone Number *
Candidates Email Address *
Candidates Membership Number (SIC Number)
Briefly outline the goals you wish to achieve during this programme (e.g. Weight Loss, Improved Fitness, Group interaction, strength gains etc.) *
Do you have a Heart Condition (Angina, chest discomfort)? *
Have you ever suffered a stroke? *
Do you experience pains in your chest at rest or during physical activity/exercise? *
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance? *
Do you have asthma? *
Do you have Diabetes?                                                                       -If yes, have you had trouble controlling your blood glucose in the last 3 months? *
Do you have any diagnosed muscle, bone, or joint problem that could be aggravated by physical activity/exercise? *
Do you have any diagnosed medical condition(s) that may make it dangerous for you to participate in physical activity/exercise? *
Is your doctor currently prescribing any form of medication (e.g. tablets for blood pressure, a heart condition, inhaler etc.)? *
Have you previously been advised by your doctor not to partake in physical activity? *
Please provide any history of injury Sport Ireland Campus Fitness instructors need to be aware of when planning your programme: *
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