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

 Signature of Lache Representative

Attended Lache Code of Practice induction:

Signatures?

Hold/drag mouse to draw signature

 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.

 

St. Columba's Church Hall, Plas Newton, Chester, Cheshire, CH2 1SA, Tel: 01244 535788

Registered Charity 1123789