Sports Agreement  
Recreational Activities..
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PARTICIPANT’S DETAILS
Title: *
First Name: *
Last Name: *
Address: *
Telephone Number: *
Date of Birth: *
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Email: *
Emergency Contact's Name (in case of emergency): *
Emergency Contact's Telephone Number: *
                                           MEDICAL QUESTIONNAIRE
Regular exercise is associated with many health benefits, yet any change of activity may increase the risk of injury.
Please complete questionnaire to help us avoid injury to you.
Which sport are you filling out this agreement for? *
1.) Have you ever received professional medical advice discouraging physical activity? *
2.) When you undertake physical activity, do you feel pain in your chest? *
3.) Have you experienced chest pains in the last month, whilst not being engaged in physical activity? *
4.) Have you ever experienced a loss of consciousness or dizziness? *
5.) Do you have a joint or bone ailment that may worsen due to a change in your physical activity? *
6.) Is a doctor currently prescribing you medications for blood pressure or a heart condition? *
7.) Are you pregnant? *
8.) Are you an insulin dependent diabetic? *
If you have answered “YES” to any of the above questions, please check with your doctor BEFORE you join sessions.
TERMS & CONDITIONS
Not all activities are suitable for everyone. If you ever feel any discomfort or pain, do not continue. You should understand that when participating in any activity or activity programme, there is the possibility of physical injury or even death. Wycombe Warriors Ltd accept no liability for injury, illness or health problems arising from your participation in any activity or activity programme you receive. You are voluntarily choosing to participate in an activity and you agree that any information, instruction or advice obtained from Wycombe Warriors Ltd's activity session will be used entirely at your own risk. You agree to disclose any physical limitations, disabilities, ailments or impairments to your health that may affect your ability to participate in any session and take part entirely at your own risk.

Wycombe Warriors Ltd will not be responsible for loss, damage or theft of individual’s property or belongings on the site. You will agree to comply with appropriate conduct and use of facilities. You will also adhere to attire suitable for the activity.

Charges apply per session.

The facilitator reserves the right to exclude anyone from the session on medical grounds or excessive lateness. Wycombe Warriors Ltd may make reasonable changes to the times of sessions, provided it gives advanced notice of these changes.
PARTICIPANT DECLARATION
By selecting the "signature" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this agreement.
I agree to comply with the above terms and conditions. *
I give permission to be photographed and images used for promotion *
Date:
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Signature (print name): *
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