Register for Teenfit

The purpose of this information is to ensure we provide every young person the highest level of care. This information must be updated annually.
  • Date Format: DD slash MM slash YYYY
  • Please tick all that apply
  • Please tick your preferred payment options
  • Ideally this should be someone different to the parent/guardian named above
  • PARTICIPANTS GENERAL HEALTH INFORMATION

    If you answer yes to any of the questions below, our Trainers may ask for more detail at the time of your first visit.
  • If yes, please provide details including the affect area, activities which cause pain and severity.
  • If yes, please provide details including the affect area, activities which cause pain and severity.
  • Include type of epilepsy (Grand mal or Petite mal) Frequency of attacks Date of last attack
  • If yes, please provide details including type of surgery, any pain or discomfort you experienced and any other information we may need to know
  • If yes, please specify and advise of any side-effects experienced
  • If yes, please specify and advise of any allergy management plans in place
  • If yes, please specify and advise of any management plans in place
  • If yes, please specify
  • INFORMED CONSENT

    To be completed by the parent/guardian providing the above information
  • Please tick any and all that are applicable