Recreational Running Club Pre-Participation Evaluation
Personal Information
Full Name
Date of Birth
Contact Number
Email
Emergency Contact
Name
Relationship
Phone
Medical History
Do you currently have or have a history of any of the following?
Current Medications (if any)
Allergies
Has your doctor ever advised you not to participate in physical activities?
No
Yes
Physical Activity & Running Experience
How often do you engage in physical activity?
Never
1-2 times/week
3-4 times/week
5 or more times/week
Describe your running experience
Consent & Signature
I confirm that the above information is correct to the best of my knowledge.
Signature
Date