Trial Session | SixSigma Female Gym

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GYM HEALTH DECLARATION

To register to our gym trial, please fill out the following medical form

First Name

Last Name

Email Address

Birthday

Do you have any exisiting heart conditions, diagnose asthma, chest pain, stroke, high/low blood pressure? If Yes, Please specify or indicate No.

Do you suffer from any major muscle or joint conditions that may limit you or be aggravated by phyiscal activity? If Yes, Please specify or indicate No.

Emergency Contact Name

Emergency Phone Number

Date of Trial Session:

I declare that the info I’ve provided is accurate & complete. I am fully and personally responsible for my own safety and actions, with full knowledge of the risk involved. I hereby release, waive, discharge all liability and claims that I may have against Six Sigma Gym with respect to bodily injury, personal injury, illness or death.

Thanks for submitting!

420 Joo Chiat Road,

#02-01, Singapore 427641

info@sixsigmagym.com

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