Step 1 of 2 50% Name* First Last Which Parish Are You Staying In?*St. LucySt. PeterSt. JamesSt. ThomasSt. MichaelChrist ChurchSt GeorgeDate* PhoneAgeHeight*Weight (lbs)*In Case of Emergency Contact Name & NumberShare your current fitness regime:* Health QuestionnaireAre you currently under a doctor's care?*YesNoPlease Explain:History of chest pains, heart problems or stroke*YesNoHistory of heart problems in immediate family*YesNoHigh Blood Pressure*YesNoAny Chronic Illness or Condition*YesNoHernia or any condition that may be aggravated by lifting weights*YesNoRecent surgery (last 12 months)*YesNoPregnant (now within last 3 months)*YesNoHistory of Breathing or Lung Problems*YesNoMuscle, Joint or Back disorder or any previous injury that is still affecting you*YesNoDiabetes or Thyroid condition*YesNoCigarette Smoking Habit*YesNoObesity (Over 20% over ideal bodyweight)*YesNoIncreased Blood Cholesterol*YesNoPlease Explain any 'Yes' answers above:I certify that all the above information is correct. (Please type full name below to confirm)* This iframe contains the logic required to handle Ajax powered Gravity Forms.