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PAR-Q Liability Waiver

This form must be completed once only, before your first Zumba or Clubbercise session. Please read the relevant notes below for each class.

Zumba Fitness
Zumba is an Aerobic workout.

Clubbercise
Clubbercise is an aerobic exercise class taught in a darkened room with flashing lights. If you suffer from any form of photosensitivity or light sensitivity this class is not suitable for you.

Listen to your body, take the class at your own pace and choose lower impact options if you find the high impact moves too challenging. Stay hydrated during the class, drink whenever you need it.

1. Are you experiencing one or more of the following COVID-19 symptoms High temperature, continuous cough, loss of smell or taste?

2. Have you ever suffered with epilepsy?
WARNING: Flashing lights are used in Clubbercise classes

3. Are you pregnant?
If yes, how many months?

4. Have you ever suffered from heart trouble?

5. Are you presently taking any form of medication?

6. Do you suffer from chest pains?

7. Do you ever have spells of dizziness or feel faint?

8. Have you ever had either high or low blood pressure, and/or high cholesterol?

9. Have you ever had asthma, chronic bronchitis or any other chest ailments?

10. Do you suffer from severe back pains or any other orthopaedic problem?

11. Do you suffer from severe headaches or migraines?

12. Are you recovering from a recent illness / operation or injury?

13. Have you any medical condition that we should be aware of?

14. Is there any history of heart disease in your immediate family (before age 55)?

PLEASE NOTE: If you have answered YES to any questions 1 - 14, you are advised to seek medical advice/approval before taking part in this class.

I have been informed that if I answer YES to any of the questions 1 – 14 above I should seek medical advice/approval before commencing this class. If I wish to continue without such advice I do so entirely at my own risk. I confirm that I have read, fully understood and answered each question honestly.

I understand the nature of the Clubbercise class and confirm that I am in appropriate physical and mental condition to participate. If at any time I have questions, feel unsafe or unwell I will immediately inform the instructor (or their assistant) and discontinue further participation in the class. I understand that neither the instructor or Clubbercise Ltd can be held responsible for any injuries or ill health of any kind arising from participation within this class.

I agree to my personal contact information being used to send me important class updates. IMPORTANT: If you don’t tick this box it will not be possible to let you know about changes to classes, cancellations etc. You can unsubscribe at any time.

I agree to my personal contact information being used to send me important class updates AND other relevant updates, news and offers

Please click the Submit Form button just once, and wait for the confirmation page to load.

Data Protection - This information will be stored in line with the General Data Protection Regulation (GDPR) and the Privacy Policy of the individual or company named at the top of this document. Clubbercise Ltd will not receive this data and will not be responsible for protecting this data.

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PAR-Q Liability Waiver