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Medical Disclosure
Please fill out the following health declaration form in order to participate in our sessions.
Your Information
First Name
Last Name
Email
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Emergency Contact Information
First Name
Last Name
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Relationship to you
Your Medical Information
Do you have any medical conditions we need to know about?
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Yes
No
Job
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Special Advice Given
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Date
Initials
I understand that the Instructor is not medically qualified but has given me general advice regarding exercise and special advice where I have disclosed any medical conditions. I confirm I am undertaking this exercise class at my own risk.
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