Personal information

First Name

Last Name

Address

Phone number

Email

Gender

Male

Female

Other

Country of birth

First language

Are you of Aboriginal or Torres Strait Islander origin?

Yes

No

Do you identify as culturally or linguistically diverse?

Yes

No

Emergency Contact Name

Emergency Contact Phone Number

If you have complex or unmanaged medical conditions, you may need to attend a Tier 1 Strength for Life session with an Allied Health Professional. Please speak with your preferred Provider Site prior to Enrolment to ensure they can safely manage any existing condition.

Screening form

It is recommended that all participants enrolling in Strength for Life discuss their intention with their GP so that their ongoing health can be managed appropriately. In some situations, a GP Referral must be obtained prior to your first Strength for Life session to ensure your safety when exercising. This may apply if you answer YES to any of the below questions.

If any other medical conditions, please provide more information.

For either of the following, a bone density report is required:

Any history of cancer requiring chemotherapy or radiotherapy

Any history of Osteoporosis

None of the above

Holdfast Strength for Life

Holdfast Strength for Life enrolment request

Personal information

Screening form