Streetenvy Participant Form - Schools
Child Physical Activity Readiness Questionnaire (PAR-Q) & Application Form

Please fill in one form per family member(s) in BLOCK CAPITALS.

For most people physical activity should not pose any problem or hazard.  PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or those who have medical advice concerning the type of activity most suitable for them.  For your own safety, please answer the following questions as honestly and accurately as possible.

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Please select which school you are booking for *
Participant’s Full Name: *
Sex/Identity *
Date of Birth *
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Permanent Address *
Email contact (parent or guardian) *
Name of parent/guardian completing form *
Relation to participant *
Parent or guardian emergency contact (telephone number) *
How did you hear about us? *
How long has it been since you participated in regular cardiovascular exercises (minimum 3 times a week) for at least 20 minutes? *
Have you ever suffered from any of the following? High blood pressure, pulmonary disease (asthma, allergies, bronchitis), diabetes, orthopaedic problem (bones/joints), eating disorders/underweight/overweight, on any medications, stroke, heart attack, coronary bypass, cardiac surgery, chest pains, uneven, irregular or skipped heart beats, faint or dizzy spells emotional disorders-stress or psychological problems. *
If you ticked yes, please inform us which of the above is relevant to the participant and give any other information regarding injury, illness or allergy including food allergies here:
Details on this form will not be shared with any third parties unless we need to retrieve unpaid fees. Participant name and numbers will be shared with the school.
Occasionally Streetenvy instructors and professionals will capture class and performance photography and videos. I, the undersigned, hereby agree to allow images and videos of Streetenvy classes and performances, including the class participant named above, to be used for advertisement without the requirement to gain further permission.

Any payment made toward Streetenvy services will not be refunded. An alternative date/s will be provided in the event of any cancellation/s made by Streetenvy.

Streetenvy clothing is available to purchase and worn at many of our performances including shows. This includes a t-shirt and bottoms (leggings and/or joggers). You may purchase this via your instructor. We do not accept kit returns but will exchange sizes if brought back to us within 14 days, unused and in it's original state.

Our classes are limited by capacity to provide the best service but to maintain the current fee for all we must be prepared for any changes. After completion of your second term/8 weeks (whichever is sooner) with us you hereby agree to provide us with a minimum of 4 weeks worth of paid classes notice of leave, in writing. These 4 weeks are to be paid in full by you, the parent or guardian of the class participant, before the end of the current term. If you hand us less than 4 weeks notice or do not return, you are still liable to pay the remaining weeks to cover this full notice period. Failure to pay this fee on time will result in an additional charge to you at 50% per week and further action taken to claim any unpaid fees. We appreciate your communication to allow our classes to run smoothly.

I, the undersigned, understand that any contact, including social media to other students and instructors must be kept friendly and professional at all times. Streetenvy will take any form of negativity, bullying or slander very seriously, possibly leading to further actions including, but not limited by, dismissal from all classes.

I, the undersigned, declare that I have answered the questions on both sides of this form as accurately and honestly as possible.  I understand and am aware that all forms of exercises including strength, flexibility, balance and aerobic (cardiovascular exercises) can be potentially hazardous to one’s physical health.  I also understand that fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities.  I agree and accept liability for all risks of injury or death that may occur to me during this program. I agree to all Streetenvy terms and conditions and policies as found on the Streetenvy website and as outlined on this contract of participation.
Signed by (parent/guardian age 18+) - name: *
Signed by (parent/guardian age 18+) - signature: *
Date of signature *
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