LGBT Masters Aquatics Club

Visiting IGLA Affiliated Club Member Physical Activity Readiness Questionnaire

If you're a current member of a fellow IGLA affiliated aquatics club you can swim with us for free on a temporary basis for up to 10 swims, to qualify please complete this form as below.

If you answer yes to any of the following questions, you may be asked to see a doctor and/or to allow relevant medical information to be shared, in confidence, before training with Out To Swim.

If you have any problems completing this form please send us a message through our Facebook page.

Name *
Name
Have you any history of heart problems? *
Have you any history of fainting spells? *
Have you any history of chest pain when exercising? *
Have you any history of high blood pressure? *
Have you any history of low blood pressure? *
Have you any history of breathing difficulties or Asthma? *
Have you any history of joint problems? *
Have you any history of Epilepsy? *
Have you any history of back complaints? *
Are you currently taking any medication that may affect your ability to exercise? *
Have you any history of Diabetes? *
Have you any other significant illness, or recent or serious operations? *
Do you have any major allergies or other conditions that may require emergency action? *
Do you have a mental health condition that you feel we should be aware of? *
I have answered this questionnaire truthfully and to the best of my knowledge. If my health or other circumstances change in ways that may affect my ability to exercise safely, I am responsible for informing Out to Swim. I am also aware of the risks associated with my chosen activity with Out To Swim and promise to share relevant information with Out To Swim so that those risks can be properly assessed and managed. I also understand that I have the right to say ‘no’ and withdraw from any proposed activity. *
I authorise the club to inform the relevant members of the club of any physical, medical or mental condition disclosed to ensure my safety and well being as well as that of other members of the club. Only those who need to know will be informed. I acknowledge that it is my decision whether to inform other members of the club. *
I agree to abide by the rules of the club *