Yoga Client Information Gathering

Please read the information below carefully, complete the form at the bottom of the page, and submit it before attending any of our classes or workshops.

Thank you.


Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions that follow.  if you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you tart.  If you are over 69 years of age, and you are not used to being active, check with your doctor.

Common sense is your best guide when you answer these questions.  Please read the questions carefully and answer each one honestly.

  1. Has your doctor ever said that you have a heart condition and that you should only do physical activity when recommended by a doctor?
  2. Do you feel any pain in your chest when exercising?
  3. In the past month, have you had chest pain when you were not doing physical activity?
  4. Do you lose balance because of dizziness or do you ever lose consciousness?
  5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
  6. Is your doctor currently prescribing you drugs for your blood pressure or heart?
  7. Do you know of any other reason why you should not do physical activity?

Flotality and its agents assume no liability for persons who undertake physical activity. If in doubt after completing this questionnaire, consult your doctor prior to physical activity.

Informed Consent

I, the undersigned, hereby acknowledge:

  • My consent to participate in an exercise programme designed by a trained fitness consultant.
  • My understanding is that exercises will consist of one or more of the following components: free body cardiovascular, resistance (strength/endurance) and flexibility;
  • I fully appreciate that there are potential risks involved in participation, e.g. episodes of transient light-headedness or possibly loss of consciousness, and I assume wilfully these risks;
  • I understand that I may stop or delay any exercise if I so desire and that the class may be terminated by the fitness consultant upon observation of any symptoms of undue distress or abnormal response;
  • My understanding is that I may ask any questions or request further explanation or information about the procedures at any time before, during and after the training;
  • That I have read, understood and completed the medical screening questionnaire (PAR-Q) and obtained medical clearance if necessary.

Health Commitment Statement

Your health is your responsibility. The management and staff of this organisation are dedicated to helping you take every opportunity to enjoy the services that I offer.  With this in mind, I have carefully considered what we can reasonably expect of each other.

What I promise…

  1. We will respect your personal decision, and allow you to make your own decisions about what exercise you can carry out.  However, we ask you not to exercise beyond what you consider to be your own abilities.
  2. We will make every reasonable effort to make sure that our equipment and chosen venues are in a safe condition for you to enjoy.
  3. We will take all reasonable steps to make sure that our staff are qualified to the fitness industry standards as set out by the Register of Exercise Professionals.
  4. If you tell us that you have a disability that puts you at a substantial disadvantage in accessing our equipment and facilities, we will consider what adjustments, if any, are reasonable for us to make.

What I expect from you…

  1. You should not exercise beyond your own abilities. if you know or are concerned that you have a medical condition that might interfere with your exercising safely before you use our equipment or services you should get advice from the relevant medical professional and follow that advice.
  2. You should make yourself aware of any rules and instructions, including warning notices.  Exercise carries its own risks. You should not carry out any activities which you have been told are not suitable for you.
  3. You should let us know immediately if you feel ill when using our equipment or participating in classes. Our staff are not qualified doctors, but there will be a person available who has had first aid training.
  4. If you have a disability, you must follow any reasonable instructions to allow you to exercise safely.

This statement is for guidance only. It is not a legally binding agreement between you and us and does not create obligations that you or I must meet.


    Please complete and send the form below to confirm you have read and understood the above