PRE-CLASS HEALTH QUESTIONNAIRE

Today's Date *

First Name *

Last Name *

Date of birth *

Email *

Phone *

Street Address *

Town/City *

County *

Postal code *

Emergency Contact Name *

Emergency contact phone number *

Relationship *

How did you find out about Hot Yoga Club? *

Have you done hot yoga before? *

Yes

Do you have any injuries that we should be aware of that may affect your participation in classes? *

Yes

If yes, please detail your injuries below:

Have you ever dislocated any joints? *

Yes

If yes, please detail which joint was dislocated and when:

Have you ever been diagnosed with a heart condition? *

Yes

In the past 6 months have you ever experienced chest pains during exercise? *

Yes

Do you suffer from high or low blood pressure? *

High BP

Low BP

Neither

Are you pregnant or have you given birth in last 3 months? *

Yes

Have you undergone surgery in the past 2 years? *

Yes

Do you have any other health/medical conditions that we should be made aware of that may affect your participation in classes? *

Yes

If yes, please provide details below:

Terms & Conditions

Before participating in any classes, events or workshops at Hot Yoga Club I consent and agree as follows:

1. I have answered all questions above honestly and truthfully to the best of my knowledge and understand that I exercise and partake at my own risk. I know of no reason why I should not participate in any form of physical exercise. Within the last 6 months no medical practitioner has advised me that I should not perform any physical activity. I confirm that I am in good health and able to perform exercise taught at Hot Yoga Club.

2. In the event that I have a heart condition or any other condition which may affect my participation, I have submitted a letter of permission from my doctor giving me consent to take part in classes, events or workshops at HYC.

3. I understand that the hot room is heated to approximately 105 to 108 degrees Fahrenheit / 40.5 to 42 degrees Celsius.

4. I will not hold Hot Yoga Club (The Thames Club) or any of the teachers responsible for any injuries suffered by me during a class I participate in.

5. I have read and understood HYC’s privacy policy, purchasing terms & conditions, class bookings and cancellation policy which can all be found and will be updated at www.hotyogaclub.co.uk. I understand that HYC reserves the right to refuse admission or to expel members who misuse the facilities, cause a nuisance to other members or behave in a way that HYC deems inappropriate. I understand that HYC can terminate any membership at any time. In most reasonable circumstances, any credit remaining will be refunded in full.

6. I understand that it is my continuing responsibility to inform Hot Yoga Club of any change to the answers I have noted on this PARQ.

7. I agree that all my personal belongings are my responsibility and that Hot Yoga Club does not accept any liability for loss or damage to my belongings.

Acceptance: *

I Agree To The Above

Signature *

Clear

PLEASE MAKE SURE I STAY UP TO DATE! Tick the box below to make sure you've opted in to receive email & text notifications relating to your class bookings & cancellations, notifications of places on a class from waitlists and studio news and updates *

Yes opt me in

No I'm ok thanks