Movement Foundations Online Health and Waiver Form

Online Class Health Questionnaire and Waiver
Full name*

First NameLast Name
Date of Birth

MonthDayYear
Date
E-mail*
Phone Number*

Area CodePhone Number
Clients informations - Health questionnaire (Par-Q)
Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

Par-Q*

	Yes	No
Has your doctor ever said that you that you should only do physical activity recommended by a doctor?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Do you know of any other reason why you should not do physical activity?
Are you pregnant?
Have you given birth to a baby within the past year?

Any additional info you would like to give:
If you answer yes to any of the above, I will message you directly to discuss prior to you taken an online class.

I have read, understood and completed this questionnaire. I will contact Emily Doe at Movement Foundations to ask any questions I have, prior to taking an online class.
Initials*

Effacer
Liability waiver
*** Please note, You must complete the online Health Questionnaire prior to being sent your class Zoom link. By completing the questionnaire you are acknowledging that you are choosing to do Pilates or Movement Workshops in your own space and you are assuming responsibility and liability for being aware of your surroundings and limitations as well as screen sharing with others who have the ability to see you. You absolve Movement Foundations (Emily Doe) of liability when using this service ***
Initials*

Effacer
Additional Information
If you miss a class, you are welcome to join in with the next one on the schedule. Those who pay for a monthly subscription to Online Classes can join any class on the schedule. Those that only join 'drop in' classes must wait for the next 'drop in' class. Donations (only give what yoiu can afford) are very welcome for 'drop in' classes - you can donate via PayPal (click image below) to make the donation to MOVEMENT FOUNDATIONS SCHOOL PROGRAM. Thank you for your support!

The first time you join a Zoom meeting you may be asked to enter your name and email address. You will be able to see me and I will be able to see you, as will other participants (unless you turn off your camera). We will be able to talk to each other and ask questions if we would like. Its easy to use! For Mat classes you will need a mat (or carpeted floor) you can also bring your favourite props to class - a ball to roll your feet, an overball if you have one and a flex band could be useful, but are not necessary for these classes. A small towel or cushion could also be good to have nearby.

NB. Time zone is GMT.

I look forward to seeing you on the Mat!

Once again, thank you for your support in transitioning to online classes.

Emily x
Initials*

Effacer
Client Signature
Signature*

Effacer
Date

JourMoisAnnéehi me messaoudMinutesAM/PM Option
Data Protection

In accordance with the General Data Protection Regulation of 25 May 2018, all data supplied to and held by Movement Foundations Limited, can be used by them to contact you and to administer their business operation. This information will be kept securely by Movement Foundations Limited and will NOT be shared with any third parties. You may request to see any data held about your school at any time by submitting a request to the Director Emily Doe. By submitting this form you agree that Movement Foundations Limited can email you about Online Classes and Company News.
Should be Empty:

Online Class Health Questionnaire and Waiver

Clients informations - Health questionnaire (Par-Q)

Liability waiver

Additional Information

Client Signature