1.

Do you have a regular aerobic fitness training program?"

If yes provide details of the nature, frequency, intensity and duration of your exercise program.

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Yes o  No o

2.

Do you have a regular and systematic strength training program?

If yes provide details of the nature, frequency, intensity and duration of your exercise program.

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Yes o  No o

3.

Have you ever had heart disease or dysfunction?

If yes provide details.

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Yes o  No o

4.

Are you currently on medication for high blood pressure?

Yes o  No o

5.

Are you currently on medication for adult onset diabetes?

Yes o  No o

6.

Do you suffer from asthma in a way which would prevent you from from being involved in continuous exercise of a vigorous and strenuous nature?

Yes o  No o

7.

Do you have any bone or joint problems which would prevent you from being involved in continuous exercise of a vigorous and strenuous nature?

Yes o  No o

9.

Do you suffer from epilepsy?

Yes o  No o

10.

Do you suffer from fainting/dizzy spells?

Yes o  No o

11.

Are you currently on medication for depression?

Yes o  No o

12.

Is there anything at all about your health that you feel you should disclose before you participate in an assessment of your physical fitness. If yes, provide details.

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Yes o  No o