Agreement, Informed Consent & Waiver Full Name *House number & Street name *City / town / village *CountyPost code *Phone number *Email Address *Date of birth *Day *Month *Year *Emergency contact & phone number *Emergency contact's relationship to you *Do you have any of the following conditions, or does any of the following apply to you? *Heart Condition, pacemaker or defibrillatorPregnantGiven birth in last 9 monthsCirculatory conditionJoint Problems or hypermobilityRheumatic or osteoarthritic conditionsNeurological conditionsAsthma, Bronchitis, CPOD, or other respiratory conditionHigh or Low Blood PressureDizzinessScrews or PlatesDiabetesPhoto-sensitivity, Epilepsy or seizuresInjuries such as broken bones, torn ligaments or damaged tendonsAny other medial conditions that may affect you ability to safely take part in any exercise programmeNONEParticipation is at your own risk. If you replied YES to any of the above, we advise that you take appropriate medical advice from a medical professional and provide a doctors note before you attend the class. Should you decide not to follow this advice, you do so at your own risk and therefore take full responsibility for any illness or injury resulting from participation in class. You are advised to listen to your body and take it at your own pace during the sessions. You will be made aware of the exercises in advance and you can choose not to participate if you have any health issues, injuries or illnesses. If you have answered YES to any of the above, please provide additional informationParticipation *By entering into this Agreement you agree that, if you experience any discomfort or pain during a Class, you will stop participating immediately and inform the Instructor and take appropriate medical advice from a medical professional. Revive Fitness instructors are not medical professionals or medically trained and cannot offer you any medical advice.Exercising at home (live streaming classes) *You are responsible for your safety in your own home and must check your home environment for risks before the class. Pets and children are not permitted in the exercise area. Please allow adequate space to perform the exercises. Check the space around you to ensure no sharp objects, fragile objects, overhead objects such as lampshades and light fittings. Ensure you have an exercise mat or soft surface to perform floor exercises. Inspect for trip hazards. Check the suitability of your equipment prior to the class. Revive Fitness Classes does not accept responsibility for the suitability of the equipment you use in your own home.Personal responsibility *I understand that I am responsible for my own safety during LIVE fitness classes and take full responsibility for the suitability of my environment and equipment used.Drugs & alcohol * I agree that I will not attend any class, while under the influence of drugs or alcohol Class objectives and risks *I understand that the purpose of the exercise class is to provide safe, group exercise to improve health and fitness. Exercises may include: Cardiovascular activities such as walking/jogging/running/side-stepping/aerobic/dance/jumping/rebounding and other similar activities; body-weight exercises and activities involving equipment such as resistance bands, weights, kettlebells, boxing equipment and rebounders. You must take full responsibility for the condition of the equipment used and check its suitability before use.Photos & video *I am aware that videos maybe recorded for record keeping and for the purpose of insurance. If I do not want to be included in promotional videos or pictures I will let it be known to the instructorDecleration *By completing this declaration I confirm that I have read and understood the above information. I have answered all questions truthfully and to the best of my ability. I understand the fitness class exercise programme I will be taking part in. I have asked any questions I may have regarding the programme and they have been answered to my satisfaction. I understand that I am free to withdraw at any time. The information obtained will be treated as private and confidential.Informed Consent *I have read and consent to the following agreement: Agreement’ means this ‘Revive Fitness Client Agreement’, which contains the terms upon which you engage in Revive Fitness ‘Class’ means any scheduled session or period of time spent undertaking or discussing physical activities and/or exercise and/or training with, and/or under the direction of, Revive Fitness Classes. 'Emergency Contact’ means a person, who is likely to be contactable and available whilst you are attending a Class, whom your Revive Fitness Instructor can contact in the event of an emergency. 'Instructor’ means a representative of Revive Fitness Classes who will host and direct your Class. 'We’ or ‘Our’ means Revive Fitness Classes. Information we collect: We require your full name, address, phone number, email, date of birth and details of any medical conditions. We also require the name and phone number of an emergency contact. This information is required so that we can contact you if classes are cancelled, rescheduled or otherwise changed. Medical information is for insurance purposes only. Under the GDPR, we do not share that information with any one else. We cannot and do not use this information for any other purpose other than stated. You will not receive any marketing or promotional information from us, unless you explicitly sign up to do so.Submit formPlease do not fill in this field.
