Informed Consent Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.I am filling this form out for: *MyselfMy ChildIf you are a guardian filling this out for a Child please provide their details and enter your contact details under Emergency Contact.Name *FirstLastEmail *Date Of BirthAddress *Telephone Number *Emergency Contact *FirstLastHave you ever had any of the following: *Heart conditions or chest pain?High or low blood pressure?Faintness or dizzy spells?Asthma?Diabetes?Had any operations in the last year?Any recent injuries?Bone or joint problems?Prescribed medicines?Dietary supplements?Other? (Please provide details below)N/AIf you answered yes to any of the above please provide details: (We advise you check with your doctor before attending classes)Do you participate regularly in any activity/exercise – if yes, please give details. What are goals/aims of exercise?Photography and video consent *I ConsentI understand participation may result in the occasional group/individual photograph being taken or the performance being filmed. I hereby agree to allow my instructor to use any photographs or filming for advertising purposes only on the company website or related advertising space. First Aid *I agreeI give a permission for the instructor who is qualified First Aider to administer First Aid to Myself/my child, or take Me/my child to Accident and Emergency, or call for medical assistance and to sign on my behalf any consent forms required by medical authorities when the first aid situation occurs. Parent/Legal Guardian consent *I Consent for my childI’m filling this form out for myselfIf a filling in the form as a parent or legal guardian I confirm that I agree for my child to participate in the session described above and that I understand my child is able to withdraw from the session at any time. consent participate yes Informed Consent *I consentThe aims of this Aerial Stilettos sessions are to improve cardiovascular fitness, muscular strength and endurance, flexibility, and to learn new skills and moves. Most session will begin with a warm up then a recap of moves learnt the previous week. We will then learn a series of new moves or transitions. This will follow with a routine, finishing with a cool down, incorporating stretches to improve flexibility. Please notify the instructor before the session if you have sustained any injuries, illnesses or medical conditions or if you feel there are parts of the session you are unable to take part in. Participation is completely voluntary. All information given to the instructor is completely private and confidential under data protection legislation. Please ask as many questions as possible during the session, especially if you do not completely understand any move that is demonstrated. As with all exercise, especially aerial hoop/aerial silks classes carry an element of risk and you may experience some bruising or burn, tenderness around the backs of your knees and on the palms of your hands and feel slightly achy for a few days afterwards. This session has been designed to minimise those risks and with continued practise your body will become conditioned to the movements involved. If during the session you feel excessive pain or discomfort, please notify the instructor immediately. By signing this voluntary release, I fully recognise that if I/my child or anyone else is hurt or damaged while I/my child engaged in any activity during my session with Aerial Stilettos instructor, I will have no right to make a claim or file a lawsuit against them, regardless of the reason for my injury or damage. I agree and promise to accept and assume all responsibility and risk for injury or arising injury, death, illness or disease or damage to myself/my child from my participation in these classes. Myself/my child participation in these classes is purely voluntary and I am electing to participate in spite of these risks. Submit
