Health Registration 2021

Exercise Class registration

For any of Kate's Classes
Your commitment to me (KW Wellbeing)

You should not exercise beyond your own abilities. If you know or are concerned that you have a medical condition which might interfere with you exercising safely, before you attend a session you should seek advice from a relevant medical professional and follow that advice.

You should make yourself aware of any rules and instructions, including warning notices.

Exercise carries its own risks. You should not carry out any activities which you have been told are not suitable for you.

For on line classes, you should ensure that the space around you at home is suitable to exercise in and is clear of any potential dangers.

For face-to-face classes you should ensure that you follow instructions regarding spacing and access to and from the room.

If you have any health issues you should make these known to Kate prior to commencing the session.

If you are new to exercise then you should follow the lowest level offered and build from there, taking responsibility for your own health & wellbeing.

If you have a disability, you must follow any reasonable instructions to allow you to exercise safely.

This statement is for guidance only. It is not a legally binding agreement between you and me and does not create any obligations which you & I must meet.
Contact details*

First Name Last Name
Date of Birth

MonthDay Year
Date
E-mail*
example@example.com
Mobile Number*
Please enter a valid phone number.
Emergency Contact Name & Number*

Name Number
What class(es) are you registering for?*
What is your occupation?*

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	Yes	No
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?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (eg back, hips or knees) that could be made worse by a change in physical activity?
Is your doctor currently prescribing you any medication for blood pressure or a heart condition
Do you know of any other reason why you should not do physical activity?

	YES	NO	N/A
Have you had Covid-19
Have you experienced any prolonged symptoms?
Have you been told that you have Long Covid?

Exercise Class registration