Medical History

Have you been treated/diagnosed for any of the following?

Are you on medication?
Please indicate your reason for participating in classes?

Tick box for consent

Please note: as with any exercise program, you must follow the instructions given. Failure to do so may result in an injury, in respect of which the course organiser will have no responsibility. The instructor has relied on the information supplied by you on this form. However, I do not profess to give medical advice and if you received advice not to exercise you must adhere to same. Under no circumstances continue with any exercise that causes you pain or discomfort, as the organiser will have no responsibility for the injury arising from same.