Name
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First Name
Last Name
Email
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Phone
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(###)
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Date Of Birth
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MM
DD
YYYY
1. Do you currently have any of the following:
Fill in the box if the answer is yes
2. Have you ever been diagnosed with any of the following:
Fill in the box if the answer is yes
3. Are you aware of any disability or impairment that would make attending a Haus Of Spin class hazardous or detrimental to your health, safety and/or wellbeing?
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4. Do you ever have pains in your chest while performing any physical activity?
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5. Have you ever had pains in your chest while performing physical activities of any kind?
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6. Have you ever lost your balance due to dizziness?
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7. Have you ever lost consciousness?
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8. Have you recently had surgery?
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9. Are you currently taking medication, either prescription or non-prescription?
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10. If you answered "yes" to question 9, are you aware whether this medication may affect your ability to exercise?
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11. If you answered "no" to question 10, have you checked with your medical practitioner?
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12. If you answered "yes" to any of the above questions, please elaborate below/over and seek guidance and a clearance in writing from your physician or health professional prior to undertaking any physical activity or exercise.
Please note: Riding while affected by stimulant recreational and prescription drugs poses a significant risk of heart attack, seizures and death. By signing this waiver you agree that you will not participate in classes at Haus Of Spin under the influence of these drugs. By signing this waiver, you agree to notify Haus Of Spin if your health condition changes at any time during the period of time that you participate in Haus Of Spin classes. If your health condition ever presents a limitation on your physical activity level, please notify your instructor and seek their prior advice on the appropriate modifications to your session. By submitting this waiver, you also agree that Haus Of Spin is not responsible for the loss or theft of any personal property in the studio or property surrounds including in lockers or with our concierge service. By signing this waiver, you agree that you meet the minimum height requirement of 150cm.
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Sign with your name and date
