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LLL Sign Up Form

Please fill out one of the below forms, please note only offline payments are accepted e.g. Invoice, automatic direct debit, or bank transfer.

Are you an existing HSP member?

 

If you already have a membership with us please fill out the below form, if you are a new member please scroll down and fill out the 'LLL Sign Up Form'

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Current Membership
Weekly
Monthly
Other
Payment Method

Are you new to HSP?

 

If you are new to HSP please fill out the below form.

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General Information

Title
Mr
Mrs
Miss
Ms
Date of Birth
Prefer communication
Email
Text
Both

Terms and Conditions

Click HERE to view the terms and conditions

Upon signing this agreement, you herby agree to the terms and conditions detailed above.

Date of signature

Pre-Exercise Medcial Screening

Please indicate YES or NO for each question

CARDIOVASCULAR AND PULMONARY CONDITIONS

Diagnosed heart condition or stroke?
Yes
No
Diagnosed pulmonary disease?
Yes
No
Unreasonable chest pain during exercise?
Yes
No
Blood pressure over 140/90 or below 100/80?
Yes
No

HISTORY

Do you consistently feel faint or suffer from spells of dizziness?
Yes
No
Pregnant currently or in the last 12 months?
Yes
No
Do you have epilepsy?
Yes
No
Do you have arthritis?
Yes
No
Are you currently taking any blood pressure medication?
Yes
No
Do you suffer from asthma and require medication?
Yes
No
Currently or quit smoking/vaping within the last 6 months?
Yes
No
Any known bone or joint problems that could be aggravated by exercise?
Yes
No
Any known injuries?
Yes
No
Any conditions that may increase risk of adverse reaction to exercise?
Yes
No

Emergency contact person

INFORMED CONSENT

HSP Health and Safety Policy Statement

Click HERE to view the HSP health and safety policy statement

Membership Option and Payment Method

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