Medical Waiver

Each student should complete a Medical Waiver, so, in case of an incident, emergency details are easy to locate. Below is a sample Medical Waiver. Specific details that need to be included in a Medical Waiver will differ from country to country, but this is a good starting point.

This information must not be shared with anyone. It can be stored electronically, or hard copies can be kept in a folder.

Please complete before the commencement of class

Name: _____________________________________________________________________________

Email: _____________________________________________________________________________

Mobile Number: _________________________________ Other: _______________________

Contact person case of emergency:

Name: _____________________________________________________________________________

Mobile: ________________________________________ Other: _______________________

Please read the following carefully:

  • Classes are open to any person provided they are medically fit and can participate in the class

  • Classes run for one hour. You are encouraged to stay within your own comfort zone and rest when needed

  • Warm-ups and cool-downs are part of the class and these are a requirement of the class

  • If you have any doubt that you are medically fit to attend the class, you are required to obtain a medical clearance from your health care professional prior to commencing the class

  • If any details contained in this form change at any time, it is your responsibility to notify the instructor

  • Please indicate (below) if you have a condition or ailment which you think the instructor should be aware of

    _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

    If the instructor believes an ambulance is required, I give him/her permission to call an ambulance

I understand there is an inherent risk in any exercise activity and I have read, understood and agreed to the above points.

Signature: ____________________________________________ Date: __________________