1Tick.co.za Digital forms Fitness Questionaire Example It looks like your internet is very good, do you want to synchronize the data? Total Signed: Total Returning: Sync data Thank you for completing our waiver form. Your submission for Fitness Questionaire Example event was processed successfully. Hi - welcome! Please let us know if you are a new customer, or a returning customer.... Make a selection New customer Returning customer (please use same email address). Name * Surname * email * Are you a new customer? I'm a new customer Are you completing this on behalf of a minor? Make a selection No Yes For legal Guardian (All fields compulsory) Guardian Full Name and Surname * Relationship to minor * Guardians valid Email Address * Guardians contact number (also for emergencies) * Minor 1 Remove Minor's name * Minor's Surname * Minor's date of birth * Day1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MonthJanuary February March April May June July August September October November December Year2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 Minor's gender * Make a selection Male Female Minor's age * Make a selection 123456789101112131415161718 Any medical conditions * Make a selection Yes No INSERT DETAILS HERE Add another minor First name First name * Last name Last name * Email Email * Contact Number Contact Number * Any medical conditions we need to be aware of? Any medical conditions we need to be aware of? * Make a selection Yes No Emergency contact person Emergency contact person * Emergency contact number Emergency contact number * Gender Gender * Make a selection Male Female Gender diverse Age Age * Make a selection 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100+ Medical Aid Medical Aid * Medical Aid Number Medical Aid Number * Do you prefer AM or PM workouts Do you prefer AM or PM workouts Make a selection AM PM How fit are you? How fit are you? Make a selection Not at all fit A little Average Very Fit Extremely Fit How often do you train per week How often do you train per week Make a selection Once Twice Three Times Four times Five Times Six times Every Day Company name and website Company name and website * Do you have specific fitness goals Do you have specific fitness goals By completing and submitting this form you are agreeing to the following: LIMITATION OF LIABILITY 1) You agree and acknowledge that you will not hold Xtreme Gym liable for any loss, damage or theft on the part of its employees, independent contractors, consultants jshsjhs jshsjshhs sjhshsh shhshshs hshshsh hshowowuwk wwnwsjsn nwshshsh skhsjsjshsjhs jshsjshhs sjhshsh shhshshs hshshsh hshowowuwk wwnwsjsn nwshshsh skhsjsjshsjhs jshsjshhs sjhshsh shhshshs hshshsh hshowowuwk wwnwsjsn nwshshsh skhsjsjshsjhs jshsjshhs sjhshsh shhshshs hshshsh hshowowuwk wwnwsjsn nwshshsh skhsjsjshsjhs jshsjshhs sjhshsh shhshshs hshshsh hshowowuwk wwnwsjsn nwshshsh skhsjs If you have any further questions please contact 1Tick I agree to these terms and conditions
