Sarah Bfit Classes

PARQ - please fill this form with as much detail as possible.
Name of Participant*

First NameLast Name
DOB*

DayMonthYear
Date
Email*
example@example.com
Phone Number*
Emergency Contact*

Name & relation (to you)Contact Number
Please read the following questions carefully and check (X) next to the appropriate answers. Answer all questions honestly and to the best of your ability.

YES/ NO*

	Yes	No
Has your doctor ever said that you have a heart condition (had a stroke, heart attack, or heart surgery) and/ or 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?
Have you ever been told by a doctor that you have bone, joint, or muscle problems that could be made worse by physical activity?
Do you have a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Have you seen a chiropractor, osteopath, acupuncturist, or other alternative medicine practitioner in the last year?
Are you pregnant now or have given birth within the last 6 months?
Have you had a recent surgery?
Are you currently on any medications, either prescription or non-prescription, on a regular basis?
Do you know of any other reason why you should not do physical activity?

If you have answered 'Yes' to any of the above, please elaborate below:*
Fitness Participation Agreement I have answered the questions above to the best of my ability and affirm that my physical condition is good and I have no known conditions that would prevent me from participation. I acknowledge that participation is at my own pace and comfort level and that I may discontinue my participation in the sessions at any time. Furthermore, I agree to self-determine my exertion through good judgement and to discontinue any activity that exceeds my personal limitations. I understand that by signing this agreement that I hereby waive and release Sarah - Bfit in any way from liabilities or demands as a result of injury, loss, or adverse health conditions as a result of my participation. I affirm that I have read and understand this document and I wish to participate in fitness activities at my own risk.
Signature of Participant: *

Clear
Parent/ Guardian Name (Under 18’s)
Parent/ Guardian - Signature (Under 18's)

Clear
Date*

DayMonthYear
Please tick which classes you are interested in*

DancePilates - via ZoomPilates/ Fitness - 1:1Pilates - group class (face to face)General FitnessStrengthFlexibility/ Stretch
Thank you for thaking the time to fill in this form.

See you in class.
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