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Name
*
Full Address
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Email
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Phone
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Emergency Contact Name
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Emergency Contact Phone
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Submit
Name
*
Full Address
*
Email
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Phone
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Emergency Contact Name
*
Emergency Contact Phone
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Has your doctor said that you have a heart condition and should only do exercise recommended by a doctor?
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Do you feel pain in your chest when you do physical activity?
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Do you lose your balance because of dizziness or do you ever lose consciousness?
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Are you pregnant or given birth within the last six months?
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Are you currently taking any prescription medicine for a chronic medical condition?
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Do you have any medical conditions the instructor should be aware of?
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If Yes:
Occasionally photos will be taken during class and shared on social media, do you agree?
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