PAR-Q Name(required) Date of birth (YYYY-MM-DD)(required) Address(required) Telephone number(required) Email(required) HAVE YOU EVER HAD ANY OF THE FOLLOWING: Heart condition or chest pain? Yes No High or low blood pressure? Yes No Faintness or dizzy spells? Yes No Asthma or Diabetes? Yes No Are you pregnant or post natal? Yes No Have you had any operations in the last year? Yes No Have you any recent injuries? Yes No Have you any bone or joint problems? Yes No Are you on any prescribed medicines or dietary supplements? Yes No Have you any other medical conditions not previously mentioned? Yes No 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: INFORMED CONSENT: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 notifythe instructor before the session if you have sustained any injuries, illnesses, or medical conditionsor 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. PARTICIPANTS NAME: (required) DATE: (YYYY-MM-DD)(required) PARTICIPANTS SIGNATURE:(required) Submit Δ Share this:TwitterFacebookLike Loading...
The most unique way to keep fit! Pole Dance & Fitness classes, lessons in exotic Pole dancing and Stretch classes in Burnley and Padiham 