Benja health profile

Confidential - 2 min health check required before training. For kids and adults.

Name *

Email address *

Phone Number *

What is your main goal! *

Date of Birth *

Emergency Contact Name & Phone *

Do you have any medical conditions? (asthma ,heart, Diabetes etc) *

Current or past injuries? *

Allergies? *

Are you over 18 years or older? *

For under 18 - Parent/Guardian Name

I consent to Benja Athletic collecting and storing my health information confidentially to safely deliver personal training. *

I consent to Benja Athletic sharing relevant health alerts (e.g. asthma, severe allergy, emergency contact ) with my coach and the host gym ONLY if needed for my safety in an emergency. *