HEALTH & PARTICIPATION DECLARATION

I confirm that I have answered all questions in this form honestly and I am aware that if I have answered yes to any of the questions I will need to consult my GP before continuing.

I acknowledge that it is my sole responsibility to assess my own physical condition and readiness to participate.

If I answer “YES” to any of the conditions listed below, I understand that I should consult with a qualified healthcareprofessional before participating.

I acknowledge that the program provider is not a medical professional and does not provide medical advice, diagnosis or treatment.

By proceeding, I voluntarily accept full responsibility for my health, safety and participation and I agree that I participate at my own risk.

If you currently or have ever suffered from any of the

following conditions please speak with a medical

professional before starting.

1) Heart problems

2) Circulatory problems

3) Blood pressure problems

4) Joint or movement problems

5) Feel dizzy or imbalanced during exercise

6) Currently pregnant or recently given birth

7) Back or spinal pain

8) Headaches or migraines

9) Recently had surgery

10) Currently being prescribed medication

11) Recently finished a course of medication

12) Asthma or breathing problems