MOTIV8 FITNESS & NUTRITION
Pre/Post Natal Health Declaration
Please complete the form before attending any Bloom'n FiT by Motiv8 session. We recommend all clients consult with their Doctor prior to participation in any of our classes. For all Post-natal clients regardless of delivery mode, we recommend you are assessed by a pelvic health physiotherapist before participating in any of our classes.
Are you currenty:
Choose an option
Pregnant / Pre-Natal
Pre-Natal Clients, please confirm the following:
I have consulted with my Doctor and he/she has not advised against any exercise activity.
There have been no complications during my pregnancy to date.
I exercised regularly before becoming pregnant.
Post Partum Clients, please confirm the following:
I have had my 6-week checkup and my Doctors has not advised against any exercise activity.
There were no complications during the pregancy and/or delivery.
I exercised regularly during my pregnancy.
Waiver Release. Please acknowledge the following:
I understand that participation in any exercise programme, while pregnant or immediately following a pregnancy, may increase the risk of injury to myself and, if applicable, to my unborn child. I confirm that I have consulted with my Doctor regarding my participation and the risks I may encounter and he/she has given me permission to participate in this pre/post-natal exercise programme.
I understand that the level of my participation in the exercise program and which exercises to perform must be determined by me, in consultation with my Doctor, and that Motiv8 Fitness and the instructor are not responsible for the intensity of my participation.
I understand that the Motiv8 Fitness instructor is not a Doctor, nurse, or health professional, and that they are not undertaking any responsibility regarding my medical condition(s).
I will discontinue the exercise program and will consult with my Doctor immediately should my medical situation change (e.g. pain, bleeding, discharge or cramps) about continuing or resuming participation in this or any exercise programme.
I hereby personally assume any and all risks associated with participating in this exercise program.
I hereby release, indemnify and hold harmless Motiv8 Fitness and the instructors of the exercise program I have chosen to attend, from any and all claims, demands, personal injuries, costs, or expense, arising from or relating in any way to my or my child’s participation in the pre/post-natal exercise program.
Should a provision of this agreement or portion thereof be found invalid or void as against public policy by any court of competent jurisdiction, the remainder of this agreement shall nonetheless remain in full force and effect.
I acknowledge that I have read and understand this Waiver, Release and Indemnity Agreement and have been given the opportunity to ask any questions and have received and understand all of the information which was provided.
Thanks for submitting!