Next Level Performance Training

NEXT LEVEL PERFORMANCE TRAINING

Participant's First Name

Parent/Guardian name

Parent/Guardian Phone Number

Date of birth

Grade in Fall 2021

Any restrictions on participation

Has your doctor ever said you have high blood pressure?

Do you lose balance because of dizziness OR have lost consciousness in the last 12 months?

Are you currently taking prescribed medications for a chronic medical condition?

Has your doctor ever said that you should only do medically supervised physical activity?

Participant's Last Name

Parent/Guardian E-Mail

Emergency contact if different from parent and phone number

Age

Name of School

Has your doctor ever said you have a heart condition?

Do you feel pain in your chest at rest, during daily activities of living, OR when you do physical activity?

Have you ever been diagnosed with a chroninc medical condition (other than heart disease or high blood pressure)?

Do you currently have (or have had within the past 12 months) a bone, joint or soft tissue (muscle, ligament or tendon) problem that could be made worse by becoming more physically active?

I have read and understood to my full satisfaction and completed the questionnaire

If you answered NO to all of the questions above - you are cleared for physical activity.

Please check the PARTICIPANT DECLARATION box

If you answered YES to one or more of the questions above , you must have a doctor's clearance to participate in training

I accept VK release/waiver

I accept COVID-19 release/waiver