INDIVIDUAL REGISTRATION FORM
Your Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
NIC
(Required)
Gender
(Required)
Male
Female
Your Address
(Required)
Address
City
Preferred Method of Contact
Email
Phone
Your Phone
(Required)
Email
Emergency Contact Number
(Required)
Emergency Contact Name and Relationship
(Required)
Height (cm)
(Required)
Please enter a number from
5
to
250
.
Weight (Kg)
(Required)
Please enter a number from
5
to
250
.
Medical History/Pre-Existing Conditions:
Chronic Medical Conditions:
(Required)
Asthma
Diabetes
Heart Disease
None
Other (please specify)
Specify
Allergies:
(Required)
Food Allergies
Diabetes
Heart Disease
None
Other (please specify)
Specify the allergy
Previous Injuries or Surgeries:
(Required)
Yes (Specify)
No
Specify Injuries
Current Medications:
(Required)
Yes (Specify)
No
Specify current condition
Any other medical conditions, restrictions, or limitations recommended by a healthcare professional: (yes [Specify] / no)
Membership Type
(Required)
Ladies
Gents
Membership Type
(Required)
One Month
Monthly with a Personal Trainer
Six Month
Annual
Total
Δ
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Get In Touch
Call Us
+94 77 007 0101 +94 71 733 1255
Meet Us
Kandy Sports Club, Nittawela.
Email Us
staff@xfitnesskandy.com
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. All rights reserved.
