Name
Address
DOB
Email address
Mobile No
PARQ: please answer the questions below
Do you have any existing medical conditions that may effect your ability to participate in exercise?
Are you taking any regular prescription medication?
In the past twelve months have you suffered any major illness or surgery?
Certain medical conditions can be adversely affected by increasing exercise, I understand that the instructor Tara Veasey-Watts is an exercise professional qualified to deliver an exercise session but not a medical practitioner. I hereby declare that to the best of my knowledge, I am able to participate in an exercise class and I understand that if I have any existing medical conditions that I should seek professional medical clearance before undertaking a new exercise regime. If I choose not to do this then I accept responsibility for my actions and no liability can be placed upon the instructor Tara Veasey-Watts.
Signed client
Date (client)
Signed instructor
Date (instructor)
How did you hear about TJH Dance & Fitness please circle?
LeafletAdvertReferral / word of mouth
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