• Heart condition or chest pain?
  • High or low blood pressure?
  • Faintness or dizzy spells?
  • Asthma?
  • Diabetes?
  • Are you pregnant or post natal?
  • Have you had any operation the last year?
  • Have you any recent injuries?
  • Any bone or joint problems?
  • Are you on any prescribed medicines or dietary supplements?
  • Have you any other medical condition not previously mentioned?

If you answer yes to any of the above questions, please detail below. We would recommend that you seek advice and confirmation from your doctor prior to participating in the class.


Do you participate regularly in any activity or exercise? What are your goals and aims of exercise? Please give details below:


The aim of the session is to improve cardiovascular fitness, muscular strength and endurance,  
flexibility and to learn new pole fitness moves. The sessions will begin with a warm up and then a 
recap of moves learnt from the previous week. We will then learn a series or new moves or transitions, finishing with a cool down incorporating stretches to improve flexibility. Please notify
the instructor before the session if you have sustained any injuries, illnesses, or medical conditions
or if you feel that there are parts of the session you are unable to take part in, participation is 
completely voluntary. All information given to the instructor is completely private and confidential 
under data legislation. Please ask as many questions as you need during the session, especially if you do not completely understand any move demonstrated. As with all exercise, pole fitness classes carry an element of risk and you may experience some bruising or burn and feel slightly achy for a few days afterwards. This session has been designed to minimise the risks and with continued practise your body will become conditioned to the movements involved. If during the session you feel excessive pain or discomfort, please notify the instructor immediately. Sign below to confirm that you have agreed to participate in the session described above and that you understand you are able to withdraw from the session at any time.

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