Well-Being Afternoon Registration

Welcome! Please complete this registration & health screening form to join our Well-Being Afternoon session. It only needs completing once unless any updates to your health are required. Please ensure all information is accurate and up-to-date before submitting. All information is confidential and used solely to ensure your safety during the session.

Full Name *

Email Address *

Mobile Phone Number *

Emergency Contact – Full Name *

Emergency Contact – Mobile Phone Number *

Do you have any injuries, medical conditions or limitations that might affect your participation? *

If yes, please describe your injuries / conditions

Are you currently any doctor, physiotherapist or healthcare provider for any injury or condition?

If yes, please provide details;

Do you have any mental health conditions or considerations (e.g. anxiety, depression) that might affect your participation? (Optional)

Are you taking any medications we should be aware of that could affect your participation? (Optional)

Would you like to speak to me directly before coming? (Optional)

If ticked, I’ll be in touch to arrange a convenient time to discuss any questions, concerns, or additional information.

I confirm that I have answered these questions honestly and will notify the teacher of any changes to my health, physical or mental. I understand participation is at my own risk

I consent to my information being used solely to register me for this class and to ensure my safety during participation.