• Pre Activity Readiness Questionnaire Form

    Adults Registration Form
  • Date of Birth*
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    2 digit month, 2 digit day, 4 digit year

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    Answer the following questions as honestly as you can and provide as much relevant additional information.

     

  • Medical Questions

    Do you currently or have you ever suffered from any of the following conditions?
  • 1) Heart Problems?*
  • 2) Circulatory Problems?*
  • 3) Blood Pressure Problems?*
  • 4) Joint ? Movement Problems?*
  • 5) Feel Dizzy or Imbalance During Exercise?*
  • 6) Currently Pregnant or Recently Given Birth?*
  • 7) Do You Suffer With Any Allergies?*

  • Health History

    Do you currently receive medical care or do any of the following affect you?
  • 8) Spinal Or Back Pain?*
  • 9) Headaches or Migraines*
  • 10) Have You recently Had Surgery?*
  • 11) Currently Prescribed Medication?*
  • 12) Recently Finished A Course Of Medication?*
  • 13) Diabetes ?*
  • 14) Asthma or Breathing Problems?*

  • Is there is any other reason that you believe may prevent you from taking part in any regular activity?

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    I have answered all questions in this form honestly and I am aware that if I have answered yes to any of the questions I will need to consult my GP before commencing the dance class. If I am affected by any of the questions mentioned in this form now or at a later date I agree to inform os Dance of any changes in health or fitness. I acknowledge it is my responsibility to inform the teacher of any injuries or continuing physical issues before my class. Declaring any medical condition does not affect your rights or standard of teaching, It is there to enhance, understand and help your learning while in class.

  • Date
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date
     / /
    2 digit month, 2 digit day, 4 digit year
  • Image field 29

  • Declaration:

  • I understand and agree that I will be supported in achieving physical activities as part of my dance tuition.

    I agree that I may have my photograph and video taken for evaluation of skills and technique development and these may be published by OS Dance on websites as well as advertising and marketing materials which may include social media.

    I agree that my personal details can be held on the confidential Oliver Saxon Dance Teacher database. This information is for Oliver Saxon Dance Teacher use only. However, in case of emergency, we shall share the appropriate information with the emergency services.

    I agree that I will follow the code of conduct as set out by OS Dance while attending classes.

    I agree that OS Dance will not be held responsible for any Lost, Stolen or Damage valuables that are brought to Class/Venue.

    I agree to inform OS Dance of any changes /updates to my registration form.

    General Data Protection Regulation GDPR

    The information you have enter on this form is being collected by OS Dance and will be stored and processed both manually and electronically. Your personal details are required in order to contact you. This forms the lawful basis under which we collect this information; without it we cannot get in touch with you or do business with you.By submitting this form you confirm that you understand that OS Dance, will store and process your personal details within GDPR guidelines. We have a legal duty to keep your information secure and we will only use your details to provide our services to you. We will not share your information with any third party but we may use third party suppliers to store your data and to help us keep it secure. We collect as little information as possible to provide our services to you.If we no longer require the information you provided we will dispose of it securely. You have the right to access the information we hold about you and we will supply this to you in an electronic format if you ask us. You can request that we delete your personal details and we will comply with that unless we are prevented by law or other regulations, for example due to record keeping, safekeeping or accounting purposes.

    I have read and agree to all the policies set out by os Dance. By signing below I agree to the Permissions & Declarations above.

  • Date
     / /
    2 digit month, 2 digit day, 4 digit year
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