Physical and Medical Prescreening Form

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    Name:
    Have you experienced any of the following (check those that apply):
    Have you ever suffered from any of the following (check those that apply):
    Do you take any prescription medication?
    Are you pregnant?
    Are you exercising at present?
    What level are you exercising at currently?
    What are you hoping to gain from these exercise sessions?
    Exercise Advice:

    Beginners: Please work out at a slower pace, gauging how you feel as you go, and concentrating on correct technique (please ask, if unsure). As you continue to attend the studio, you should improve in fitness and strength, therefore you will be able to work a little harder each time.

    Please ensure you:

    • Wear comfortable, sensible and suitable shoes and clothing.
    • Work out at a sensible pace, as you are responsible for the health of your own body.
    • Inform your instructor if you feel unwell, faint, or dizzy.
    • Inform your instructor if your health status changes in the future.


    Statement/Declaration:

    I declare that the information given in this form is true and complete to the best of my knowledge. I understand that all participants take part at their own risk and must accept personal liability for any injury, illness or loss.

    I declare that I consider myself to be in good health and fit to participate in my chosen activity.

    I recognise that all possible care and qualified instructing is given to me during a training session, but I take full responsibility for my person, and I understand that any injury or loss incurred during a session is at the discretion of Body & Soul Gym’s insurance advisors as to whether Body & Soul Gym is subject to any liability for the injury or loss.

    I recognise that the instructor is not able to provide me with medical advice with regards to my fitness and that this information is used as a guideline to the limitations of my ability to exercise. I have answered the questions to the best of my ability and understand the advice above.

    I hereby represent to Body & Soul Gym, its management, associated companies, trusts, partnerships and other legal entities, their directors, officers, employees, agents, contractors and affiliates, that I am physically capable of participating in my chosen activity/program, and there is no medical reason to prevent me from proceeding with any program run by Body & Soul Gym. I acknowledge that whilst participating in the activities/program, my person and my property are at my own risk.

    Whilst I acknowledge that every reasonable and practicable effort shall be made by Body & Soul Gym to ensure my safety, I accept full responsibility for avoiding personal injury or loss, either to myself or others present; in the event that injury or loss should occur, I accept and will abide by the decision of Body & Soul Gym insurance advisors as to whether Body & Soul Gym is subject to any liability for the injury or loss.

    I accept that there are no rain checks, refunds or make-up days unless at the discretion of the Body & Soul Gym.

    I hereby permit Body & Soul Gym to utilize any images and videos of myself for promotional or marketing use of their programs.

    I hereby release and will indemnify Body & Soul Gym for any injury or loss suffered by me whilst participating in any session/program.

    I have read, understood and agree to the terms and conditions of training with Body & Soul Gym.