Medical Questionnaire

Please fill out the following form to help us understand your physical condition.

Please tick the box if you have had or do have any of the following conditions:

I hereby agree to the following:

1. That I am participating in the yoga & Pilates classes offered by Nidd Valley Physio, during which I will receive information and instruction or other services offered pertaining to yoga, Pilates and health. I recognise that these activities require physical exertion which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2. I understand that is my responsibility to consult with a GP prior to and regarding my participation in classes, health programs, workshops or services. I represent and warrant that I am physically fit and I have no medical conditions which would prevent my full participation in the classes, health programs, workshops or services.

3. In consideration of being permitted to participate or receiving services, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the program or receiving any services.

4. In further consideration of being permitted to participate in classes, I knowingly, voluntarily and expressly waive any claim I may have against Nidd Valley Physio for injury or damages that I may sustain as a result of participating in the program or from receiving any services.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to terms and conditions listed above.

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