Before you shake it in class, we need a few details to keep you safe! We collect your health, medical, and contact information through this form so we can ensure you can exercise safely, we can contact the right person in an emergency, and manage your class bookings. Your health information is sensitive, therefore, we will look after it with the utmost care. We do not sell your data, and we only keep it for as long as our fitness insurance requires. You can read exactly how we protect, store, and manage your personal data by viewing our full Privacy Policy.

Please answer YES or NO to the following questions.

Do you currently or have you ever suffered from any of the following conditions:

Note: If you answered YES to one or more questions, you must consult with your doctor before commencing exercise. You may be required to provide a doctor's note.

Please read the following legal clauses carefully before signing.

1. Assumption of Risk

I, the undersigned, understand that Zumba® fitness classes involve strenuous physical activity, including but not limited to cardiovascular exercise, dance movements, jumping, and quick directional changes. I acknowledge that these activities carry inherent risks of physical injury, including minor injuries (sprains, strains), major injuries (broken bones, cardiac events), or property damage/loss. I explicitly assume all risks associated with my participation, whether classes take place indoors at a community venue or outdoors in public or private spaces (incorporating risks related to weather, uneven terrain, or outdoor surfaces).

2. Medical Acknowledgment and Clearance

Please check ONE of the options below and read the safety acknowledgment:

Ongoing Safety Agreement (Applies to all participants):
I acknowledge that it is my sole responsibility to consult with a physician prior to participating if I have any health concerns now or in the future. If at any time during the class I feel faint, dizzy, or experience physical pain, I agree to stop participating immediately, look after my safety, and inform the instructor.

3. Release of Liability
I hereby release, waive, and forever discharge Good Moves with Hemi, Highfield Church Centre, the venue owners, and Zumba Fitness, LLC from any and all liability, claims, demands, or causes of action arising out of ordinary negligence for any personal injury, property damage, or wrongful death occurring during or as a result of my participation in the class, to the fullest extent permitted by law.

4. Accuracy of Information

I confirm that the answers provided in the Section 2 Health Screening (PAR-Q) are true, accurate, and complete to the best of my knowledge. I agree to inform the instructor immediately should my health status change at any point in the future.

5. Public Health & Outdoor Safety

For classes held outdoors, I agree to wear appropriate footwear and clothing suitable for the weather and surface conditions. I acknowledge that the instructor is not responsible for environmental elements like heat, cold, sun exposure, or insects.

6. Photo and Video Media Consent

Good Moves with Hemi may take photos and videos during the classes to be used for promotional and marketing purposes, including but not limited to social media platforms (such as Instagram), websites, and flyers. These materials are used without compensation to or further approval by participants of the classes visible in them.

If I prefer not to be photographed and/or filmed and/or for these materials to be used for the above stated purposes, I understand it is my responsibility to inform the instructor before the class begins so I can be placed outside the camera's view.

By signing below, I acknowledge that I have read, fully understood, and agree to both the processing of my personal and medical information disclosed in Sections 1 and 2, as set out in the Privacy Policy, and to the terms set out in the liability waiver stated above. (If the participant is under 18, a parent or legal guardian must sign).