Please complete the following form and submit prior to participating in our live Zoom and specialty classes. This covers both you and the studio in case of an accident, as well as letting us know important information so we can adjust your program or make recommendations accordingly.

    HEALTH SCREEN & LIFESTYLE QUESTIONNAIRE

    Medical Considerations

    CURRENT ACTIVITY PATTERNS

    DISCLAIMER

    I understand that undertaking any type of physical activity involves an element of risk. I understand that, while all appropriate safety precautions are taken, I am exercising at my own risk. I take it upon myself myself to discuss any changes in my current health status with my instructor or a medical practitioner.
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    ONLINE CLASSES
    ​I understand that if participating in Online Classes without the direct supervision of my instructor, that I am solely responsible for creating a safe exercise space, and I agree to exercise within my physical limitations, and follow any safety recommendations given by my instructor. 

    To the best of my knowledge, the information I have provided above is true and correct.

    STATEMENT OF MEDICAL CLEARANCE

    If you answered yes to any questions from 1-6, or are over the age of 35 and have not participated in light to moderate exercise for the past year, it is recommended that you seek Medical Clearance from a Certified Health Practitioner prior to participation in an exercise program. 
    If you have been given verbal clearance or a recommendation by your Doctor / Physiotherapist / Chiropractor or other health practitioner to undertake exercise as part of your health or recover plan, please complete the following below.

    ​I, 
    hereby certify that I have sought medical advice from my Doctor / Physiotherapist / Chiropractor / or other Allied Health Professional, in regards to the above outlined conditions, and have been given verbal clearance or recommendation to undertake exercise in a supervised program.