Gym Induction Form

To be completed by a Representative of Chester Heart Support Group and retained in Gym Records File

Contact Details

Discharge forms received from Countess of Chester Hospital:

Yes

No

Letter from Doctor:

Yes

No

Programme cannot be commenced until discharge details have been received

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 Signature of Lache Representative

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Attended Lache Code of Practice induction:

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 Signature of participant 

Attended exercise suite familiarisation induction:

I confirm that I have received a copy of the “Lache Guidance Notes for people using the Lache Community Centre Gym” and agree to comply with the rules listed and adhere to the programme guidance contained.

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