Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

D.O.B: *

MM

DD

YYYY

Have you ever experienced any of the following, past or present, when resting or when active? *

Please tick where appropriate.

Shortness of breath / asthma

Allergies / hay fever

Chest pain

Heart disease

High blood pressure

Low blood pressure

Blood disorder

Epilepsy

Diabetes

Hypoglycaemia

Arthritis

Muscular injuries

Ankle problems / pain

Knee problems / pain

Pelvic problems / pain

Back problems / pain

Neck problems / pain

Shoulder problems / pain

Wrist problems / pain

NONE OF THE ABOVE

Are you suffering with any pregnancy related muscular skeletal problems at the moment?

Yes

No

Do you have any children already?

Yes

No

Please add me to your mailing list, so that I can receive news & updates *

Please see our privacy page for details on how I use your data. I'll treat it very carefully, never share it with anyone and I promise to only send useful, informative info by email (and not bombard you!)

Yes please

No thanks

Every precaution will be taken to ensure you are safe during participation in the class. You are aware the nature of the classes and any risks involved. You must stop if you feel signs of fatigue, strain or any discomfort. There exists the possibility of certain dangers when exercising. They include abnormal blood pressure, fainting, irregular, fast or slow heart rhythm, and in rare instance, heart attack, stroke or death. Please be aware the following are warning signs to stop exercising when you are pregnant: vaginal bleeding, being out of breath, dizziness, headache, chest pain, calf pain or swelling, amniotic fluid leakage. Whilst every care is taken, it is impossible to predict the body’s exact response to exercise. You agree that you are physically capable of participating in the sessions and accept full and complete responsibility for your own participation in the class. Your Instructor shall not be liable to you for any indirect or consequential loss or damage including loss of earnings arising out of your participation in classes. You are aware you must let your Instructor know if there is any change in your health. The Woodland Workout is an outdoor fitness class whatever the weather. Please wear appropriate clothing whether it’s wet, cold or hot. You will understand that the class takes place on a natural terrain where there are are hazards such as tree roots, twigs, leaves etc so please take your own precautions and watch where you are treading when we jog or run especially. You accept full liability for any injury that may arise when you are on the property of Victoria Corbett or within the class itself. For pregnant participants: Your midwife, GP or Consultant is aware you are participating in this exercise class. I agree to the terms and conditions stated above

Yes, I agree

No, I don't agree

Signed *

Please enter your full name here to signify that you have read and completed this form in full.

First Name

Last Name

Date *

MM

DD

YYYY