Thank you for choosing FitnessMechanics.ca. We look forward to having you join our programs. Please fill out the following information completely. This will help us to design the best program for you and your circumstances.  If any information is left out, we may contact you to obtain it before developing your program.

**ALL FIELDS ARE MANDATORY**

NEW MEMBER SIGN-UP
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Age:
Sex: Male       Female
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 YES! I agree that by signing up for a yearly commitment membership, I cannot cancel my mebership until 12 months have passed from my date of sign-up.


1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
     Yes     No
2. Do you feel pain in your chest when you do physical activity?
     Yes      No
3. In the past month, have you had chest pain when you were not doing physical activity?
     Yes      No
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
     Yes      No
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? If so what are they?
     Yes      No       Describe:
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
     Yes      No
7. Do you know of any other reason why you should not do physical activity?
8. What exercise and experience level would you consider yourself?
10. What do you want your program geared towards?

11. Comments/additional info:
I have read and agree to the Terms & Conditions.
(Must be checked before we can accept your membership!)

By clicking the accept button; I, the client have read, agree and except the terms of membership to Fitness Mechanics. Further more, I have been informed, understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment are potentially hazardous activities. I also have been informed, understand and am aware that fitness activity involves a risk of injury and that I am voluntarily participating in these activities and using equipment with full knowledge, understanding and appreciation of the dangers involved.
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