Health Waiver

Please fill out this health waiver form to continue with booking classes

First and Last name

Are you pregnant and/or have any of the following: heart disease, asthma, high blood pressure, high cholesterol level, diabetes, significant bone/joint/muscle pain, back pain?

Yes

If marked Yes, please explain

Are you active: sports, activity and/or exercise? If so, how many times a week?

Do you have any injuries, aches or pains? (recent or old)

Yes

If marked Yes, please explain

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete. I understand my physical limitations and am sufficiently self-aware to stop physical activity before I become ill or injured. I agree not to hold Body Equilibrium Studio liable for any illness or injury caused during or after a session.

Thanks for submitting!