Indicates required field
Gender
As part of our duty of care, it is a requirement to ask all participants, no matter what age, to complete the following questions.
Has a family member (under 60), suffered from heart disease, stroke, raised cholesterol or sudden death?
Are you a male over 35, or a female over 45 and not used to regular exercise?
Have you been hospitalised recently?
Do you have any Heart Condition?
Are you pregnant?
Do you have high blood pressure (>149/90)?
Do you ever have Palpitations or pains in the chest?
Do you have high Cholesterol/Triglycerides?
Do you have, or have you ever had?
Are you dieting or fasting?
Do you have any pain or major injuries in the following areas?
Are there any conditions that would require you to modify your exercise program?
Are you on any prescribed medication?

Participants self clearance *

If any of the above conditions have been experienced, please either obtain physician's clearance to exercise prior to commencement or sign below if the condition has already been cleared by your doctor.

It is recommended that males over 35 and females over 45 should have a medical assessment including an ECG and cholesterol/lipid count. Should you suffer injury, illness, or a condition in the future, please complete this form again.

I acknowledge that I will choose my exercise intensity based on my personal level of health and fitness and I am choosing to do so at my own risk.

Please tick

*Users are required to respect and comply with the Conditions of Entry as set out in the Code of Conduct to provide an appropriate environment for sport, recreation, and leisure services.

**By becoming a user of Five Dock Leisure Centre and Concord Oval Recreation Centre, I agree to receive email communication from the Centres. I understand I can unsubscribe at any time.

***I give permission for photographs or videos showing images of me and my children to be taken whilst we are at the Centres. I also give permission and consent for the photographs or videos showing images of me and my children to be used at the Centre’s sole discretion for the purposes of internal and external communications, which may include but are not limited to advertising and marketing, email marketing, and posting on the Centre’s official social media accounts including Facebook, Instagram, and Website. I understand that I can withdraw the above consent at any time by advising the Centre in writing.

For more information, please contact us via email: info@concordrec.com.au

*All participants under the age of 18 are required to have a parent or legal guardian sign the clearance form in person at the facility. Clearance forms submitted electronically or online will not be accepted.