Personal Details

Learning Support for You

Please provide us with any information that will help us to meet your learning needs, indicate any disability/learning difficulty applicable.

Do you have a disability that may affect your study?

Do you have a learning difficulty that may affect your study?

Medical History Questionnaire

Please tick the relevant boxes to each of the questions below.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a Doctor?

Do you feel pain in your chest when you do physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint injury that could be made worse by a change in your physical activity?

Is your Doctor currently prescribing drugs for your blood pressure or heart condition?

Do you know of any other reason why you should not do physical activity? (provide details below)

If you have ticked 'yes' to any question, you MUST provide written consent/authorisation from your doctor to undertake a FIT UK training programme. This must be uploaded with this application form.

Programme Details

Course Title Course Code Venue Price
Total Cost £

Relevant Qualifications

How did you hear about us?

How are you paying?

Student Declaration

I have read, understood and agree to the ‘Terms & Conditions’ provided, and confirm that the details I have given on this form are correct (please tick):

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