Movement Alchemy
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    Pre-Class / Workshop Questionnaire

    As you are the planning to take part in physical activity please answer the questions below. If you are between the ages of 16 and 69, the questionnaire will tell you if you should consult with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. All information will be treated confidentially.

    Health Information
    ​If you have answered 'NO' to all questions:
    You can be reasonably sure that you can take part in the workshop.
    Please note: If your health changes so that subsequently you answer yes to any of the above questions, please let me know before the workshop. 

    I have read and fully understand this questionnaire. I have answered all questions to the best of my knowledge.  My participation in the workshop is voluntary and entirely at my own risk. I will only participate in the workshop at an exertion level that I am comfortable with and will stop exercising immediately if I feel discomfort or am experiencing any pain and I will inform the instructor of my symptoms. I understand that I am free to withdraw from the activity at any time.
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Movement Alchemy 2020
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