ParQ Form — YogiFit

Name

First Name

Last Name

Date of Birth

YYYY

Sex

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Occupation

Mobile Number:

Emergency Contact and Mobile

Personal Health History

Medication

Are you taking any prescribed medication? Please provide details:

Details of any medication being taken.

Hospitalization

Have you been hospitalized or undergone any surgical proce-dures in the last 12 months? Please provide details:

.Details of any hospitalization:

Pregnancy

Are you pregnant or have been in the last 3 months?

If your answer is YES to any of the above, please give further details as doctor’s note may be requested.

Pain

Do you have any pain or major injuries, particularly in the following areas?

***NO, None of these***

Neck

Back

Knees

Ankles

If you answer YES to any of these, please give brief details:

Anything Else?

Is there any other reason not mentioned above, why you might not take part in any physical activity?

If YES, please give brief details:

Terms and Conditions for YogiFit

Your Health We strongly recommend that you seek medical advice before participating in an exercise programme. Participants who proceed without first doing so, do so at their own risk. If you have an accident or sustain an injury during one of the classes you must inform the Trainer immediately. If you require medication such as an inhaler, it is your responsibility to have these with you while participating in the sessions. Session bookings PLEASE NOTE • A period of at least 72hrs (3 days) notice must be given prior to session cancellations. If a session is cancelled within this time period then the following will apply: • Re-schedule (within a 7 day period) . I will try to my best to re-schedule at a time that suits your preference, however, this may not always be possible. • If you cannot re-schedule within the 7 day period you will be charged for the missed session in full. • All sessions must be paid for in advance Yogifit reserves the right to cancel your class bookings immediately if you break Yogifit Terms and Conditions or engage in disruptive or violent behaviour.

Safety Considerations

• I understand that sessions take place online. I accept the potential dangers that my participation in sessions without instructor present may involve. • I confirm that I will inform the Trainer at the beginning of each session of any medical or other condition(s) that I may have that may affect my participation in that session. I will proceed with the session at my own risk and am fully responsible for protecting my own health and safety in relation to any conditions I have. I agree to inform the Trainer of any conditions, and where necessary, provide a written consent from my medical practitioner, before continuing with physical activity. • I agree to abide by all oral notices regarding safety and technique given during a session. I am aware that I have the opportunity to ask questions about the activities, use of equipment and other related issues during a session. If I choose to disregard any advice given, I do so at my own risk and accept liability for all resulting injuries or damage. • I understand that Yogifit is not responsible or liable for any injuries or damage resulting from my participation in the session unless where yogifit has been negligent or failed to take reasonable care.

Terms and Conditions

Do you agree to YogiFit's Terms and Conditions and Safety Considerations?

Data Protection

The information you have provided here will be used for Yogifit purposes only, we understand that some data is sensitive and treat this the way of a medical practitioner. No data will be shared with any third party without your prior permission. I hereby consent for you to process and store my information for at least 7 years for professional and legal purposes and my consent will be sought before it is shared with anyone outside of Yogifit. However, I understand that these details may be shared in the event of a medical emergency. Do you give me your permission to contact you for marketing purposes in the future?

Photography

Social media is a great promotional platform for us. We may take informal photos or video classes to help with our promotion, but we respect your wishes. Are you happy for me to use pictures and video for promotional purposes? #instagram @yogi.fit_

Contact Method

I am happy with the following methods of contact:

Mobile number

Home Phone

None of the above

Confirmation statment

I confirm that all statements on the form are correct and that I have read and understood this declaration.

Confirm Name

Form Complettion Date

Today's date

YYYY

Thank you! Your form is whizzing its way over to Jenni now.

YogiFit ParQ Form