Subscription

Adult Class Registration & Health Screening

Please complete this form before attending your first class.

SECTION 1 – PERSONAL DETAILS

Full Name*

Email Address*

Mobile Number*

Date of Birth*

Full Postal Address

I`d love to receive birthday cards and occasional studio updates by post from Yallar dance Studio.

Emergency Contact Name*

Emergency Contact Phone*

Preferred Location

SECTION 2 – HEALTH SCREENING (PAR-Q)

This form is not medical advice. If you answer YES to any question, please ensure you have checked with a GP/healthcare professional.

1. Has a doctor ever said that you have a heart condition or that you should only do physical activity recommended by a doctor?

Yes

2. Do you feel pain in your chest when you do physical activity?

Yes

3. In the past month, have you had chest pain when not doing physical activity?

Yes

4. Do you lose balance because of dizziness or have you ever lost consciousness?

Yes

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes

6. Is your doctor currently prescribing medication for blood pressure or a heart condition?

Yes

7. Are you currently pregnant, recently post-natal, or returning to exercise after pregnancy?

Yes

8. Is there any other reason why you feel you should not take part in physical activity?

Yes

If you answered YES to any question, please briefly explain:

SECTION 3 – PARTICIPATION AGREEMENT

I confirm that the information I have provided is accurate and complete.

I understand that participation in classes is at my own risk.

I agree to follow instructor guidance and modify movements where needed.

I understand that if I feel unwell, dizzy, or uncomfortable, I should stop immediately and inform the instructor.

SECTION 4 – MEMBERSHIP TERMS

I understand that my membership keeps my spot in the class, even if i missed a session

I understand that missed classes can`t be refunded, but we`ll always try to offer flexible options where possible

I understand that I need to cancel my membership, I`ll give at least 30 days`s notice by email yallarbellydance@gmail.com

SECTION 5 – PHOTO & VIDEO CONSENT

Yes, I consent to photos/videos being used for marketing purposes

No, please do not include me in photos/videos

By submitting this form, I confirm that I am 18 years old or over.

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