CrossFit Competitor Health Disclosure
Full Name
Date of Birth
Contact Number
Email Address
Medical History
Heart Condition
Respiratory Issues (e.g. asthma)
Orthopedic Injuries
Diabetes
Hypertension
Allergies
Epilepsy/Seizures
Other Conditions
Details of Medical Conditions (if any)
Emergency Contact
Name
Phone
Additional Information
Current Medications
Recent Injuries/Surgeries (last 12 months)
Signature
Date