JC FAMILY FITNESS 

To register to our fitness program please fill out the following form

Do you or anyone in your immediate family have any heart conditions?
Do you feel pains in your chest when partaking in any form of physical activity?
Do you feel chest pains at any other time eg (waking up in the morning)?
Do you ever feel dizzy, faint or lose consciousness?
Has your doctor ever informed you of high blood pressure?

Thanks for submitting!