Curious about joining the Attak Squad? Welcome!

Pre-Exercise Questionnaire Agreement 

1. Medical Status Declaration

'Tick' the boxes that apply:

I confirm that I have NO known pre-existing or current medical conditions that would impact my ability to exercise safely.

I HAVE or HAVE HAD the following condition(s):

High blood pressure

Heart conditions or any cardiovascular conditions

Suffered a stroke

History of coronary heart disease in your family 

High cholesterol 

Major illness or surgery in last 5 years

Dizziness, felling faint, or blackouts during exercise 

Hernia in the last 12 months

Asthma requiring medical attention in the last 12 months

Epilepsy 

Diabetes and having trouble controlling your blood glucose in the last 6 months

Currently on prescribed medication that may hinder your ability to safely exercise

Pregnant or have given birth in last 8 weeks

Arthritis or other joint/macular pain  

Other  

2. Declaration & Acknowledgment of Risk

I, {name}, of {Address}, declare that the information provided in this questionnaire is true, complete, and accurate to the best of my knowledge.

• I acknowledge that I am responsible for updating Base Attak Pty Ltd regarding any future changes to my medical condition.

• I confirm that I am medically and physically fit to participate unless indicated otherwise.

• I understand that physical activity involves inherent risks, including but not limited to injury, illness, or adverse changes in health.

• I accept full responsibility for any risks resulting from my participation, except where injury is caused by gross negligence on the part of Base Attak Pty Ltd.

• I understand that Base Attak will rely on the information I have provided to determine whether it is safe for me to participate in training or exercise programs

• I confirm you are medically fit and not under the influence of drugs or alcohol. It is your responsibility to consult a healthcare professional before participation and inform Base Attak in writing of any relevant medical conditions.
  
  

3. Waiver & Release of Liability

To the maximum extent permitted by law, I agree to release and hold harmless Base Attak Pty Ltd, its directors, staff, and contractors from any liability arising from or in connection with my participation in any services or programs, including:

• Death;

• Physical or mental injury (including aggravation or recurrence of a condition);

• Contraction, onset, or worsening of any disease or condition;

• Any loss arising from use of Base Attak’s services or participation in its activities,

• Any condition or incident arising in connection with my use of Base Attak’s services;

This waiver affirms that Base Attak relies on the accuracy of my disclosures to provide a safe environment.

• I voluntarily agree to participate in activities offered by Base Attak Pty Ltd under the terms outlined above.
• I agree that I voluntarily assume all risks associated with exercise at Base Attak
• I confirm that I have read and understood this form and voluntarily agree to its terms as a condition of participating in services provided by Base Attak Pty Ltd.

COVID-19 & Infectious Disease

• You acknowledge the risks of COVID-19 and other infectious diseases.
  

• You agree to comply with all health directives, screening, and safety measures implemented by Base Attak or authorities.
  

• Entry may be refused or revoked for non-compliance or if you present symptoms.

Electronic Signature Consent

By signing below, I consent to the use of my electronic signature in place of a paper signature. I understand that:

• I may request a paper copy of this agreement.

• I may revoke electronic consent at any time by notifying Base Attak in writing.

{sign_date}