Full Name

Email Address

Have your ever been diagnosed with a heart condition and/or been advised that you should only do physical activity that has been recommended by a doctor? Have your ever been diagnosed with a heart condition and/or been advised that you should only do physical activity that has been recommended by a doctor? Yes No

Are you currently taking any drugs for your blood pressure or a heart condition as prescribed by your doctor? Are you currently taking any drugs for your blood pressure or a heart condition as prescribed by your doctor? Yes No

Do you feel pain in your chest when you do physical activity? Do you feel pain in your chest when you do physical activity? Yes No

In the past month, have you had chest pain when you were not doing physical activity? In the past month, have you had chest pain when you were not doing physical activity? Yes No

Do you experience loss of balance due to dizziness or do you ever lose consciousness? Do you experience loss of balance due to dizziness or do you ever lose consciousness? Yes No

Do you have a known bone or joint problem (eg. pelvis, back, knee or hip) that could be made worse by a change in your physical activity? Do you have a known bone or joint problem (eg. pelvis, back, knee or hip) that could be made worse by a change in your physical activity? Yes No

Did you suffer any pregnancy related conditions (e.g. Pelvic Girdle Pain, Carpel Tunnel, High Blood Pressure?) Did you suffer any pregnancy related conditions (e.g. Pelvic Girdle Pain, Carpel Tunnel, High Blood Pressure?) Yes No

Have the symptoms of your pregnancy related conditions subsided? Have the symptoms of your pregnancy related conditions subsided? Yes No

Have you had your 6 week midwife check and been given the all clear to exercise? Have you had your 6 week midwife check and been given the all clear to exercise? Yes No

Do you have any other pre-existing medical conditions? Do you have any other pre-existing medical conditions? Yes No

Please provide details of your pre-existing medical conditions.

Do you know of any other reason why you should not do physical activity? Do you know of any other reason why you should not do physical activity? Yes No

You should always consult your healthcare professional before changing your diet or starting a new exercise programme. This class is usually safe and suitable for any mother who has been deemed fit by the healthcare professional following your 6-8 weeks check. However, as will all fitness activity, there is a risk of physical injury. I understand that participation in Sling Strong is of my own will and at my own risk. If I experience discomfort or if my medical condition changes, I will make my instructor aware prior to the class or immediately when experienced and cease exercising. I hereby assume full responsibility for any injury, losses or damages which may occur while participating in any Sling Strong programme. I hereby assume full responsibility for my baby at all times throughout the class and he/she will remain in the sling throughout any physical activity. In addition, I hereby waive all claims against Sling Strong, its instructors or partners for any injuries, losses or damages which I or my baby may incur. You should always consult your healthcare professional before changing your diet or starting a new exercise programme. This class is usually safe and suitable for any mother who has been deemed fit by the healthcare professional following your 6-8 weeks check. However, as will all fitness activity, there is a risk of physical injury. I understand that participation in Sling Strong is of my own will and at my own risk. If I experience discomfort or if my medical condition changes, I will make my instructor aware prior to the class or immediately when experienced and cease exercising. I hereby assume full responsibility for any injury, losses or damages which may occur while participating in any Sling Strong programme. I hereby assume full responsibility for my baby at all times throughout the class and he/she will remain in the sling throughout any physical activity. In addition, I hereby waive all claims against Sling Strong, its instructors or partners for any injuries, losses or damages which I or my baby may incur. I Agree