Mum and Baby Class

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example@example.com

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Postnatal check (6-8 postpartum check) - If you have not had your check please the disclaimer at the bottom of the form.

Postnatal check (6-8 weeks postpartum) If you have not had your check please read the disclaimer at the bottom of the form before signing.

Did you exercise prior and during pregnancy?

How old is your little one?

How many children do you have?

What type or birth did you have? Vaginal or C-section

Did you have an episiotomy?

Have you stopped bleeding?

Did or do you have any Pelvic Girdle Pain?

Are you breastfeeding?

Is there anything else you would like your instructor to know?

Do you have a heart condition or cardiovascular disorder?

Do you have any pain in your chest when exercising?

Do you have high or low blood pressure?

Do you have high cholesterol?

Are you on any medication? If so please specify which type and why.

Is there any reasons that you should not take place in physical activity?

As the parent or legal guardian, you are fully responsible for the care and supervision of your child at all times. Your child must remain under your direct supervision throughout the session. If your baby is not taking part in an exercise, they must remain on the mat you are using or be safely secured in their seat or pram.

Postnatal check - If you have not attended a postnatal check-up with a qualified healthcare provider and choose to participate in these classes, you do so at your own discretion and accept full responsibility for your decision. By taking part, you agree not to hold WellnessWithSamantha liable for any related outcomes.

I confirm that I have read and understood all of the information provided above and that I have answered all questions truthfully and to the best of my knowledge. I wish to participate in the Mum & Baby classes, which may include aerobic exercise, resistance training, and stretching. I acknowledge that participation in physical activity involves inherent risks, including the risk of injury and, in rare cases, serious injury or death.

I voluntarily assume all risks associated with my participation and my child’s participation and hereby release WellnessWithSamantha, as the sole instructor, from any and all claims, demands, or causes of action for injury, loss, or damage, including death, that I or my child may suffer while participating in these activities.

Signature

Date

Mum and Baby Class

All about you

Birth and Postpartum

PAR-Q

Cancellation

Consent and Disclaimer