The Mama Movement Health & Fitness Screening Form
Do you currently or have experienced any of the below in the past 12 months
IF Yes, What type of training or sport have you been doing ?
For Pregnant Mamas
How many weeks pregnant are you?
How many weeks / Months postpartum are you?
Did you have a vaginal delivery or a c-section?
Have you any pelvic pain/ gynaecologic pain/pressure? If yes, please specify.
Have you experienced any leaking of urine/ bowel movement / straining or difficulty passing urine , gas or a bowel movement ?
Health details or anything else your instructor needs to know:
POSTPARTUM MAMA 2- RETURN TO HIGHER INTENSTITY CLASS PREFERENCE
Photo Release Form for The Mama Movement
I hereby grant The Mama Movement the right to photograph myself and my dependent and use the photo and or other digital reproduction of myself and my dependant for publication and advertising processes, whether print, digital or electronic publishing via the Internet.
The Mama Movement strongly recommends that you consult with your doctor before beginning any exercise program. You should be in good physical condition and be able to participate in the exercise. The Mama Movement is not a licensed medical care provider and represents that it has no expertise in diagnosing, examining, or treating medical conditions of any kind, or in determining the effect of any specific exercise on a medical condition
Liability Release Form for The Mama Movement
I , ACCEPT ALL responsibility for my own person and my dependant, should an injury occur in any The Mama Movement Class. I assume all financial responsibility for any medical treatment necessary as a result of an injury during class. The undersigned, by signing this waiver of claim and release of liability, acknowledges that there are certain inherent risks associated with an exercise class, any of which could result in property damage or bodily injury. In consideration for the consent and right given to the undersigned to participate in exercise classes with The Mama Movement, and with full understanding of the inherent risks involved, the undersigned does, by signing below, expressly assume all risks of any nature whatsoever and hereby releases and forever discharges The Mama Movement and its employees and sub-contractors from any claim or liability of property or bodily injury of any nature whatsoever arising out of The Mama Movement’s operation, and the undersigned acknowledges full and total personal insurance responsibility while participating with The Mama Movement.