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Physical Readiness Form
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
Do you feel pain in your chest when you perform physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?
Do you know of any other reason why you should not engage in physical activity?
Waiver of Liability
It is my responsibility to consult with a physcian and I will inform the yoga instructor of any limitations before participating in a class. I understand that I am fully responsible for any medical issues that may arise. I waive and release Flourish Yoga, Health Golf and Yacht Club, its owners, and instructors from any claims related to my participation in classes offered.
I will not participate in Flourish activities if I have exhibited COVID symptoms or have been in contact with anyone with in 14 days who has been diagnosed with COVID. I also acknowledge the contagious nature of COVID & assume the risk that I may be exposed/infected when participating and release Heath Golf & Yacht Club, Flourish Yoga, & instructors from any claims resulting in a COVID exposure.
Emergency Contact Phone #:
Emergency Contact Information:
I confirm that the information given in this form is true
I accept terms & conditions
Thanks for submitting!