WARRIOR Mums & Babies Class ParQ & Consent Form
You are required to fill this form in before you attend your first WARRIOR Mums & Babies class with Eliza Flynn.
This confirms that you are in adequate health and to ensure you understand the risks that can be involved in undertaking physical activity.

Please email Eliza at hello@elizaflynn.co.uk once you have completed this.

How did you hear about the Warrior Mums & Babies classes? *
Required
Name *
Your answer
Address, including Postcode *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Mobile Number *
Your answer
Email address *
Your answer
Full Name, Relationship and Phone Number of Emergency Contact *
Your answer
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
Do you feel pain in your chest when you do physical activity? *
In the past month, have you had chest pain when you were not doing physical activity? *
Do you suffer from high blood pressure? *
Have you ever had a heart attack or bypass operation? *
Are you diabetic? *
Yes
No
Type I
Type II
Do you suffer from asthma or any respiratory conditions? *
Do you have any bone or joint problems that could be made worse by a change in your physical activity? *
Do you suffer from dizzy spells or fainting? *
Do you smoke? *
Do you suspect you may be, or know you are pregnant? *
Have you had any operations in the last year? *
Have you had any operations in the last year? *
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