General Client Details
Are you currently experiencing OR ever been diagnosed with any of the following conditions?
If pregnant, written confirmation from GP, midwife or consultant is required before entry to the class.
Physical Activity Readiness Questionnaire
In order to participate in a LiveWEll exercise class, it is essential that you complete the following questions. Should you answer YES to any of the questions, you should attend your GP for a medical screen regards your suitability and safety for exercise. Once you have visited GP, you will be asked to sign your health form before starting the class, to acknowledge and agree that you have been given clearance to exercise.
What motivated you to book a space in this class?
Please take a moment to tell us about any expectations or hopes you have regarding the class. Is there anything you hope we cover with you in the classes. Are you looking for help regarding an aspect of your health?
If you haven't done pilates, yoga or dance before, please tell us about other exercise you have been involved in.
LiveWell likes to offer previous attendees to classes preferential booking notice and offers as well as keeping everyone up to date. To do this, LiveWell uses email to update current and past clients. Please check the relevant box below regards the LiveWell email list.
Participation Informed Consent
This class will begin at a low level and will be advanced/modified within the class depending on your fitness level and ability. We may stop the exercise session because of signs of fatigue or excessive strain. It is important for you to realise that you may stop when you wish because of feelings of fatigue or any other discomfort.
There exists the possibility of certain dangers when exercising; abnormal blood pressure, fainting, irregular, fast or slow heart rhythm, and in rare instances, heart attack, stroke or death. Whilst every care will be taken, it is impossible to predict the body’s exact response to exercise. Every effort will be made to minimise these risks by evaluation of the preliminary information you provide in this form and by observations during exercise.
I understand that the Exercise Classes are specifically designed by the class instructor and will take into account details given in my health questionnaire. Therefore, this exercise should only be undertaken in a class setting, or when I have been given specific instructions to exercise on my own.
Please note that this is a Pop up trial class for a new service. For publicity purposes, LiveWell Waterford may wish to take photos during the class. LiveWell are sensitive to client's comfort and always attempt to take photos that do not show the identity of a participant. If a photo does, then you will be asked specifically for your permission to use it. These photos will be used for media purposes by LiveWell Waterford and on the LiveWell Website, publications and/or social media associated with LiveWell Waterford
THIS INFORMATION IS PROTECTED BY THE DATA PROTECTION ACT 1984.