Pre Exercise Consent Form
Everyone who is participating in an It's Time to Shine class or program is required to fill out this form before the commencement of their first session with Beverly Carter.
First Name
Your answer
Last Name
Your answer
Email address
Your answer
Phone number
Your answer
Address Line 1
Your answer
Address Line 2
Your answer
Suburb / Town
Your answer
State / Province
Your answer
Postcode
Your answer
Country
Your answer
Emergency Contact Person
Full Name
Your answer
Phone number
Your answer
Has your doctor said you have any kind of heart trouble or defect?
Diagnosed / take medication for depression, anxiety, bi-polar or anything of this nature?
Have you ever been diagnosed with diabetes, epilepsy or stroke?
Do you suffer or taking any medication for High or Low blood pressure
Are you pregnant or have had a baby in the last 6 weeks?
If you have answered YES to any of the above, please give further details below and provide medical clearance before commencing this class or program.
Your answer
Have you ever been told that you have arthritic joints/any bone or joint problem that would be made worse by exercise?
Have you ever been told you have osteoporosis? Oesteopenia?
Have you had any injuries or operations in the past 12 months?
If you answered YES to the above question please give details
Your answer
Please share any information that Bev Carter will need to support you throughout your program - including back issues, shoulder pain, tender knees etc etc
Your answer
Is there any reason, not yet mentioned, that should stop you performing physical exercise?
What would you like to feel/be/develop through regular movement sessions with Beverly Carter
Your answer
Please advise Bev before commencing this program or, immediately if your ability to exercise changes throughout the program.
TERMS AND CONDITIONS - PLEASE READ CAREFULLY BEFORE PAYMENT

N.B. It is inadvisable to commence Core and Abdominals exercises between 8 & 24 weeks of pregnancy and within 6 weeks of giving birth. For all pregnancy advise please contact Beverly directly

With all forms of physical exercise & coaching it is important to consult your doctor before you begin. This program is not a substitutes for medical counselling or treatment. If you have any doubt about the suitability of the exercises, you should refer back to your medical practitioner. Beverly Carter and It’s time to shine Pty Ltd cannot accept any liability for your personal injury related to participation, if :-

Your doctor has, on health grounds advised you against such exercise
You fail to observe instructions on safety & technique
Any injury caused by negligence of another participant

All program material/exercises/movements/programs/sequences, Classes, private sessions along with IP and terms are copyright to It’s Time to Shine Pty Ltd and Beverly Carter and can not to be shared or altered in anyway. They are for the sole use of the client participating on the Stillness in Movement program or sessions with Beverly Carter.

I acknowledge that by not undertaking a health & fitness assessment, for my activities & exercise prescribed by Bev Carter It’s time to shine without, prior written approval by medical practitioner I do so at my own risk.

Notwithstanding the above recommendations, I hereby request I participate in the exercise, coaching & activity prescribed by Bev Carter It’s Time to Shine which I shall take entirely at my own risk. I hereby waive on behalf of myself and my heirs & executors any claim of any kind whatever which I or they may hereafter have against Bev Carter It’s Time to Shine for any injury, illness or adverse change in my medical condition or state of health (whether permanent or temporary) arising directly from my undertaking of the exercise, movement & activities provided by Bev Carter It’s Time to Shine.

I have read and understand the informed consent (parent/guardian if under 18yrs) *
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