Please answer all questions below.

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Have you ever experienced any chest pain brought on by physical activity, which we should know about?

Are you aware of any heart or vascular problems that could be made worse when participating in physical activity?

Are you aware of any joint or bone problems that could be made worse by a change in physical activity?

If you suffer from asthma please consult your doctor before participating in a class.

We confirm that we will keep this information confidential and secure. we will only disclose it to the extent necessary either to protect your vital interests (for example if there is a medical emergency), or where it is necessary to do so for the purposes of liaising with our insurers or other professional advisers, or health and safety or similar experts. we ask that you sign this form to consent to us:

- Sharing this information with others, as specified above;

- Storing this information, and referring to it when we have a need for example at the beginning of a class at that you attend.

You may at any time revoke that consent, in which case we will stop processing that data. however, if that happens then we may not be able to allow you to attend a class.