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T&C Top

Health Declaration

Please fill out the following form
in order to participate in our activity.

First Name

Email

Last Name

Date of Birth

You request to participate in the Activities set out in your Dance Fit Studio Membership Agreement which includes this Waiver (Agreement) that are provided by Dance Fit Studio ACN 639 357 029 or third parties hired by Dance Fit Studio.

You understand and acknowledge that the Activities, including but not limited to access to the Studio and equipment as well as dance classes, programs, and events held by Dance Fit Studio may expose you to risk, including accidents, injury, illness or even death. You assume all risk of injuries associated with participation in the Activities, including but not limited to, falls, contact with other participants, equipment failure, impact injuries, physical risks inherent in exercise, the effects of the weather, including high heat and/or humidity and the loss of your personal property and exclude Dance Fit Studio from liability.

Because physical exercise can be strenuous and subject you to risk of serious injury, Dance Fit Studio urges you to obtain a physical examination from a doctor before using any exercise equipment or participating in any Activities. You agree that when you use the Studio, engage in the Activities, on the premises or off the premises, including at an event, you do so entirely at your own risk.

You warrant and represent that you have no injuries, physical restrictions, disabilities or predispositions to sickness or injury (Conditions) that may affect your participation in the Activities or that if you are aware of such Conditions, you participate in any activities provided by Dance Fit Studio entirely at your own risk.

You exclude Dance Fit Studio and its officers, employees and contractors, the organisers, sponsors, other participants and any other persons involved in your participation in the Activities with Dance Fit Studio (Releasees) from any demand, claim, or other proceeding in relation to any injury or death or loss or damage to personal property in connection with your participation in the Activities with Dance Fit Studio, whether or not caused by the negligence of a Releasee.

You agree to indemnify each Releasee in relation to any demand, claim or proceeding that may be brought in connection with your participation in the Activities with Dance Fit Studio where circumstances giving rise to such a demand, claim, or proceeding were caused or contributed to by you or your breach of Dance Fit Studio Membership Form and Agreement.

You agree that should any part of this Agreement and waiver be found by a court of law to be against public policy or in violation of any state statute or case precedence, then only that wording is removed and the remainder of this Agreement and waiver will remain in full force.

SCREENING TOOL
The Screening Tool below is intended for general use only and in no way guarantees against harm to health
injury or death. Dance Fit Studio accepts no liability for any loss, damage or injury that may arise from any
person acting on any information contained in this tool.

1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?

Yes

No

2. Do you ever experience unexplained pains in your chest at rest or during physical activity/exercise?

Yes

No

4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?

Yes

No

5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?

Yes

No

6. Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?

Yes

No

7. Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?

Yes

No

8. Are you pregnant or have you given birth within the last 12 months?

Yes

No

9. Do you know of any other reason why you should not participate in physical activity? If so please list below

Yes

No

IF YOU ANSWERED ‘YES’ to any of the above questions, please seek guidance from your GP or
appropriate allied health professional and return with a copy of the doctor’s clearance letter prior to starting
exercising.

Your Signature

Date signed

I declare that the info I’ve provided is accurate & complete

I agree to the terms & conditions

Thanks for submitting!

dance
fit studio

Tel. 0401 234 937
Wentworth Point Community Centre
&
Rhodes Waterfront

Terms & Conditions Policy

© 2023 by DanceFit Studio
Sydney

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our
location

indoor class
10 Footbridge Bvd, Wentworth Point NSW 2127

outdoor class
Shoreline Drive, Rhodes, NSW 2138

©2023 by DanceFit Studio

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