Youth Fit Program - Pre-Exercise Screening and Terms & Conditions

Before participating, all Youth Active members must complete a Pre-Exercise Screening Form with a parent or guardian. This form helps us ensure safety by identifying any potential medical conditions or risk factors that may affect participation in physical activity.

Does your child have, or previously had:
A heart condition?*This field is required.
A close relative who has died suddenly from a heart condition before the age of 50?*This field is required.
Uncontrolled epilepsy or seizures/convulsions?*This field is required.
Fainting or dizzy spells with physical activity/exercise?*This field is required.
Diabetes?*This field is required.
An asthma attack requiring immediate medical attention at any time over the last 12 months?*This field is required.
Anaphylactic reactions?*This field is required.
Surgery in the last month?*This field is required.
Any other conditions that may require special consideration for your child to exercise?*This field is required.
Does your child take any regular medications or supplements?
Does your child have any current health or medical management plans where they are required to carry relevant medication?*This field is required.
INFORMED CONSENT - to be completed by parent / guardian
I hereby acknowledge that:
The information provided above regarding my child’s health is, to the best of my knowledge, correct.*This field is required.
I will inform you immediately if there are any changes to the information provided above including changes to the health of my child*This field is required.
I give permission for my child to commence a physical activity program at Eaton Recreation Centre.*This field is required.
I understand that my child participates in the fitness centre activities at his/her own risk and will not hold the Eaton Recreation Centre or any of its staff responsible for any injury or harm that may occur during activities within these premises.*This field is required.
I understand that photos and/or videos will be taken from time to time for promotional purposes. I give Eaton Recreation Centre permission to use these images or videos.*This field is required.