Clearwater Therapies | Fitness Class Booking

This is a confidential pre-exercise check-list

It will only be used to make sure the classes are suitable for you

Email Address

Choose a password

Password again

First Name

Surname

Phone number (mobile)

Date of birth

Address

Postcode

Do you suffer from fainting or dizziness?

Yes No

Do you have high blood pressure?

Yes No

Do you suffer from any heart condition?

Yes No

Do you ever suffer from chest pains?

Yes No

Are you recovering from injury, illness, or an operation?

Yes No

Are you currently taking any medication?

Yes No

Are you pregnant or recovering from childbirth or miscarriage?

Yes No

Do you smoke?

Yes No

Do you ever suffer from joint pain?

Yes No

Do you suffer from

Epilepsy Asthma Diabetes

If yes to any of the above please give details here:

I understand that I undertake classes at my own risk

I consent to Clearwater Therapies processing my personal data in accordance with GDPR regulations.

I consent to Clearwater Therapies sending me news, special offers and updates via email