Medical and assurance form – Adult – Aged 19 and over

  • PRIVACY NOTICE In order to provide an effective service to our members, it is necessary for Pembrokeshire Weightlifting (known as Strength Academy Wales) to collect some personal information in this form. Information collected will be used for the purposes of the legitimate interests pursued by Pembrokeshire Weightlifting and data will be stored and protected in compliance with our legal obligations to meet GDPR standards.
  • Date Format: DD dash MM dash YYYY
  • 1. Please read and agree to the below

  • Please read and agree to the below 1. You should not exercise beyond your own abilities. If you know or are concerned that you have a medical condition which might interfere with you exercising safely, before you use our equipment and facility you should seek advice from a relevant medical professional and follow that advice. 2. You should make yourself aware of any rules and instructions (displayed at the centre), including warning notices. Exercise carries its own risks. You should not carry out any activities which you have been told are not suitable for you. 3. You should inform us immediately if you feel ill when using our equipment or facility. 4. All opening times are coached. If you are not proficient in using our equipment or at lifting techniques you must seek advice from our coaches until you become competent and able to use our equipment safely and perform exercises with good technique 5. You confirm that you are able to exercise safely. 8. In an emergency you agree to receiving medication and any emergency treatment, as considered necessary by the medical authorities present. 9. You understand that activity images may be used for promotional purposes.
  • 2. Medical conditions

  • Emergency contact details

  • Doctor’s Surgery