Welcome to Run Verity!

Name *

First Name

Last Name

Emergency Contact *

First Name

Last Name

Do you have a heart condition? *

Yes

No

Do you have chest pains when you exercise? *

Yes

No

Have you ever experienced any chest pains over the past month? *

Yes

No

Do you lose balance because of any unexplained dizziness? *

Yes

No

Do you ever lose consciousness? *

Yes

No

Do you have bone or joint problems that could be made worse by a change in physical activity? *

Yes

No

Is your doctor prescribing you drugs for blood pressure or a heart condition? *

Yes

No

Are you aware of any other reason why you should not exercise? *

Yes

No

Declaration *

I confirm that to the best of my knowledge I am able to participate in physical activity. I understand that information on these forms will be treated with strictest of confidence by RunVerity. I understand that I am responsible for monitoring myself throughout the exercise programme and that if any unusual symptoms occur, I will cease participation and inform RunVerity and my doctor of these symptoms. I am aware that physical activity can be hazardous and there is a risk involved and I acknowledge that I participate at my own risk and take full responsibility for my actions and that there will be no refund of the course fee or transfer of funds to the next course if I am unable to complete the full duration of the course for any reason.

I Confirm

Terms & Conditions *

I have read and understood the terms and conditions of RunVerity and tick to confirm that I am consenting to having opted in to receive emails from RunVerity

I Confirm