In order to save time and trees, we are asking you to please read, sign and submit this one time electronic waiver and health questionnaire for you and your child/children (if applicable) before the event. These forms will be kept on file and you will not need to fill them out again for future events with us. We look forward to seeing you!

ADULT MEMBER /GUARDIAN DETAILS

ADDRESS

Get Active Questionnaire

1. Have you experienced ANY of the following within the past six months?
2. Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active? *
3. Has a health care provider told you that you should avoid or modify certain types of physical activity? *
4. Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis, asthma, spinal cord injury) that may affect your ability to be physically active? *
6. I understand that aerial yoga is not recommended for people who have unmedicated very high or low blood pressure, easy onset vertigo, pregnancy, glaucoma, recent surgery, heart disease, osteoporosis, bone weakness, recent head injury, cerebral sclerosis, propensity for fainting, artificial hips, carpal tunnel syndrome, severe arthritis, sinusitis or head cold, recent stroke or botox injections (within 6 hours). *
7. I understand the following cautions for sound healing and I will consult my doctor prior to my sound experience if any of the below contraindications are applicable to my health: Pregnancy, epilepsy, implanted cardiac pacemaker, artificial heart valve, stent, shunt or defibrillator, cardiac arrhythmias, carotid atherosclerosis, carotid stenosis, deep brain stimulation device (DBS), thrombi, open wounds, acute inflammations and tumours, metallic implant and screws, artificial joints, whiplash *
PLEASE READ AND CLICK ANYWHERE YELLOW TO AGREE TO THE WAIVER THEN SCROLL TO THE BOTTOM AND SIGN IT
Acknowledgement of Risk and Release of Liability