Has a GP or AHP referred your child?
Do any of the following medical or physical conditions apply to your child? Tick all that may apply
Is your child currently taking any medications?
In the last 6 months has your child had any of the following (tick all that apply)
Does your child have any chronic disability or illness?
Does your child have difficulty/problems with one or more of the following
Is your child allergic to any foods, medications, pollens or allergens?
Does your child follow a special diet?
Has your child ever been diagnosed with a nutritional deficiency?
Has your child has surgery in the last 12 months?
It is strongly recommended that you consult with your physician before beginning any exercise program.
You should be in good physical condition and be able to participate in the exercise.
Matt Shorrock trading as Eye of the Tiger Coaching 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.
You should understand that when participating in any exercise or exercise program, there is the possibility of physical injury.
If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge Matt Shorrock trading as Eye of the Tiger Coaching from any and all claims or causes of action, known or unknown, arising out of any perceived negligence.
I give permission for my child to commence the exercise program.
I hereby acknowledge that the information provided above regarding my child's health is to the best of my knowledge, correct. I will inform the trainer immediately if there are any changes to the information provided above.