Athletic Development Registration

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Please use the form below to purchase your program and sign the waiver to start.

S6HP PRE- EXERCISE - MEDICAL SCREENING & WAIVER

This screening form does not provide any advice on a particular matter, nor does it substitute as advice from a qualified medical professional. No warranty of safety should result from its use and this screening form is no way a guarantee against injury or death. No liability or responsibility whatsoever can be accepted by CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD. Super 6 High Performance program, Super 6 High Performance Program, or CJSCC Pty Ltd staff, for any loss, damage, injury or death that may arise or occur from any person acting on any statement or information contained within this form.
All information will be kept confidential, please complete this form as accurately as possible.

Athlete's Name
Athlete's D.O.B.
Parent's Name (if athlete under the age of 18)
Address
Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?
Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?
Do you ever feel faint or have spells or dizziness during activity/exercise that causes you loss of balance?
Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
Do you suffer From Asthma? If so, please bring inhaler with you (if required) in line with your asthma plan.
If you have diabetes (Type I or Type II) have you had trouble controlling your blood glucose in the last 3 months?
Do you have diagnosed muscle, bone or joint problems that you have told could be made worse by participating in physical activity/exercise?
Have you been advised by a medical professional that you have high blood pressure, high cholesterol or high blood sugar levels?
Do you have any other medical condition(s) that may make it dangerous for you to participate In physical activity/exercise?
Have you spent any time in hospital (including day admission for any medical condition, illness or injury in the last 12 months?
Are you currently taking a prescribed medication(s) for any medical condition(s)?
Are you pregnant or have you given birth within the last 12 months?
Do you suffer from any allergies that would cause anaphylactic shock?

IMPORTANT NOTE:
If you answered ‘Yes’ to ANY of the above questions, please seek guidance from your GP or appropriate allied health professional prior to undertaking any physical activity/exercise with Super 6 High Performance. If you answered ‘No’ to ALL of the above questions, and you have no other concerns about your health, you may proceed to undertake physical activity/exercise with Super 6 High Performance.

Sign the Waiver Below

I understand the potential risks involved in participating in any of the rigorous physical exercise or activities within the Super 6 High Performance Program delivered by CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD. and I assume the responsibility and risks. I understand that participating in an exercise program may include, but not be limited to, serious bodily injury, heart attack, paralysis, stroke or even death. I consent voluntarily to participate in the Super 6 High Performance Program delivered, as well as the online S6HP Remote program by CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD. That the parent or guardian gives permission for their child named on this sheet to be able to participate in the online S6HP Remote, and at times communicating with the coaches and mentors within the online classroom. That S6HP Remote by CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD is not responsible for the training environment the remote athlete may choose to train, although advice will be given what a safe training environment should be, ultimately it is the responsibility of the parent of guardian of that child to control the home training environment. That CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD. any employee of Super 6 High Performance and Carl Jennings have advised me prior to my commencement of participation in cardiovascular and resistance training programs that such participation could result in physical injury. I hereby warrant that I am physically and mentally sound to proceed with a normal routine of exercise and I have been advised to consult a physician prior to commencing any physical activity. That I freely and knowingly assume the risk in all Super 6 High Performance Programs, and I hereby waive any right, claim or cause of action against CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD., Super 6 High Performance or Carl Jennings and release them from any liability for any injury, cost, damage or expense, loss of personal property or claim whatsoever arising, which I or anyone on my behalf might incur as a direct result or indirect result of my participation in the Super 6 High Performance Program(s).You acknowledge and consent to photographs and electronic images being taken of you during the Super 6 High Performance Program. You acknowledge and agree that such photographs and electronic images are owned by CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD. and the Super 6 High Performance program social media outlets S6HP website, Facebook and Instagram may use the photographs for promotional or other purposes without your further consent being necessary, these images and posts may be shared with other social media pages related to CARL JENNINGS STRENGTH AND CONDITIONING CONSULTANCY (CJSCC) PTY.LTD and the Super 6 High Performance Program. Do you agree to these terms.

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