REGISTRATION & CONSENT FORM

Your safety and wellbeing in class are really important to us at SoBolly, so I ask all participants to complete this short medical and consent form before joining. It helps me understand health conditions, offer modications, know who to contact in the unlikely event of an emergency, and make sure you’re aware of how participation in the class works.

The waiver is a standard, confidential part of running fitness and dance sessions, and completing it means you’re happy to take part at your own discretion and ability level. Thank you for taking a few minutes to complete it — it really helps me create a safe and inclusive environment for everyone.

Full name

Phone

Birthday

Day

Month

Year

EMERGENCY CONTACT

Full name

Relationship

Phone

MEDICAL INFORMATION

Any medical conditions, injuries or disabilities we should be aware of?

Yes

If yes, please provide details.

Please state any allergies.

Please review the following statements. Check the box if the answer is YES.

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Do you feel pain in your chest when performing physical activity?

Have you experienced chest pain when NOT performing physical activity in the last month?

Do you lose your balance because of dizziness or have you lost consciousness recently?

Do you have any bone or joint problems such as arthritis, which could be aggravated through physical activity?

Is your doctor currently prescribing you medications for high blood pressure or a heart condition?

Is there any reason why you should not participate in physical activity?

If you answered YES to one or more questions, are older than age 40 and have been inactive or are concerned about your health, consult a physician before taking a fitness test or substantially increasing your physical activity. You should ask for a medical clearance along with information about specific exercise limitations you may have.

In most cases, you will still be able to do any type of activity you want as long as you adhere to some guidelines.

If you answered NO (not checked any boxes) to all the PAR-Q questions, you can be reasonably sure that you can exercise safely and have low risk of having any medical complications from exercise. It is still important to start slowing and increase gradually. It may also be helpful to have a fitness assessment with a fitness instructor or personal trainer in order to determine where to begin.

PLEASE NOTE: If your health changes so that subsequently you answer YES to any of the above questions, inform your fitness or health professional immediately. Ask whether you should change your physical activity or exercise plan.

MEDICAL WAIVER & CONSENT

Please confirm you understand and agree to the following statements:

(You must agree to all to take part in any SoBolly / BollyBurn sessions.)

I understand these sessions involve physical activity

I am aware that dance and fitness sessions may be strenuous and carry a risk of injury, including serious injury or death.

I take full responsibility for my own health and participation

I confirm I am physically fit to take part and will only participate to a level that feels safe for me. I understand I should consult a medical professional before joining if I have any concerns.

I accept full responsibility for any injury, illness or property damage

I agree that I take part entirely at my own risk and that the instructors (Shreeya Patel and Yoshina Bhopal) are not liable for any injury, loss or damage I may experience during in-person or online sessions.

I waive my right to make any claim against the instructors

I agree not to hold the instructors legally responsible for any injury, death, loss or damage arising from my participation. This applies to me and to anyone who may claim on my behalf (e.g. heirs, family, legal representatives).

I understand the instructors are not liable for property or third parties

I accept that the instructors are not responsible for any damage, loss or injury to me, my belongings or anyone accompanying me at the venue.

I consent to my contact information being securely held

I agree that the instructors may store and use my details only for class-related communication and legal obligations, in line with data protection requirements.

I confirm I understand and agree to all of the above

I acknowledge that by booking or attending these sessions, I am entering into a legally binding waiver and giving up my right to take legal action.

Signature

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REGISTRATION & CONSENT FORM

EMERGENCY CONTACT

MEDICAL INFORMATION

MEDICAL WAIVER & CONSENT

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