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Welcome to Body & Balance

Health Questionnaire & Liability Waiver

To help us provide you with a safe and enjoyable exercise experience, please complete this short questionnaire before attending your first class.

This should only take about 2–3 minutes.

Personal Details

Full Name *

Date of Birth *

Day

Month

Year

Participants must be between 16 and 100 years old.

Sex at birth *

FemaleMalePrefer not to say

Email *

Phone Number *

Country / code

Local phone number

Enter the Australian number beginning with 0, such as 04.

Occupation

Health Information

How often do you exercise? *

Please tick any conditions that apply to you.

Heart conditionHigh blood pressureDiabetesOsteoporosisArthritisAsthmaStrokeVertigoRecent surgeryOther

Is there anything else your instructor should know?

Emergency Contact

Name *

Relationship *

Phone Number *

Country / code

Local phone number

Enter the Australian number beginning with 0, such as 04.

Liability Waiver

I advise that I do not have any injuries, ailments or conditions which would prevent me from undertaking Body & Balance exercise classes and that I take this class at my own risk. I understand that Body & Balance instructors are not qualified or able to provide medical advice and I indemnify Body & Balance instructors and staff against any claim that may result from my attendance and participation in Body & Balance classes.

Declaration

Signature *

I confirm that I have read and agree to the waiver above.

🔒 Your information is kept confidential and is only used to help us provide a safe and effective exercise program.

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