Royal Fusion Performing arts PAR-Q
Health and safety Par-q  (Physical Activity Readiness Questionnaire) Moderate or vigorous exercise should not be a hazard for most people providing it is undertaken as part of a regular program starting from low intensity and progressing gradually. However, some people will need medical evaluation and advice before starting a program, some may need to exercise under medical supervision and some people may only be able to undertake restricted physical activity under medical supervision.

If you answer NO to all the questions, it is reasonable for you to assume that you are in a suitable physical condition to start a regular graduated exercise program.

If you answer YES to one or more question you are first advised to consult your doctor prior to participating in any exercise program
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Email *
Participant’s Full Name: ___Birth date: ___Mobile No: ___      E-mail:___Emergency Contact name and phone:___ *
Do you have any other limitations that must be addressed when developing an exercise plan (i.e. diabetes, high blood pressure, high cholesterol, arthritis, back problems etc.)? *
Do you know of any other reason why you should not do physical activity? *
Are you aware and have you done a assessment of your workout area for hazards (please remove all hazards before entering the class!) *
Your personal data and your membership As an attendee (physical /online) of my group exercise classes, I collect, store and use the personal data that you provide me. I do this so that I can effectively manage my classes and ensure that as a participant you are kept informed and safe. I may use your data to contact you with class updates and wider group exercise related opportunities I think you may be interested in. I will use your data to keep me informed about any health or wider needs you have that I need to consider whilst delivering your class/es. If you have provided me with emergency contact details, I will use this data when required. Some of the data that I collect from you is ‘specialist category’. This includes (not exhaustively) any data relating to disabilities and health. I collect and use this data to enable me to tailor activities to your needs.I will not share your personal data. All data you provide to me is stored on a password protected device and/or locked away. The only exception to this rule is when I carry paper copies of your personal data to the class/es that you attend. I must do this so that I have your health needs and emergency contact details to hand should they be required.I would like to collect and use your personal data to keep you updated about my group exercise classes and to keep me informed about any health or wider needs you have that I need to consider whilst delivering your class/es. See above ‘Participant privacy notice’I have read the above waiver and personal data statement and I release all liability and fully understand its content. I voluntarily agree to the terms and conditions stated above. *
Required
Do you understand that using equipment during the session is at you own risk? *
Do you understand that taking part in pre-recorded youtube classes are at your own risk? *
I am voluntarily participating in the Zumba® fitness class Or other fitness classes conducted by Royal fusion performing arts(Marilyn Khan) I recognise that the program requires physical exertion that may be strenuous at times and may cause physical injury and I am fully aware of the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the above-mentioned program.I represent and warrant I have no medical condition that would prevent my participation in the program. I agree to assume all responsibility for any risks/injuries or damage known or unknown which might incur as a result of participating in the program. Such injuries may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness, including death.I understand that it is my duty and responsibility to create a safe environment should I take part in an online class whilst home. This includes, but is not limited to, checking the floor is not too slippery or sticky, removing any obstacle or object that could be hazardous or fragile, insuring I have enough space to move around as I would in a normal class, making sure I wear a proper fitness training outfit and shoes and drink enough fluid during class.In accordance with copyright infringements rules and music licensing, I understand that I will not be allowed to record the physical and/or live streaming class at any time.I further agree that, where possible, I will enable a two-way camera so that I can be viewed by the instructor hosting the virtual class (this is purely for health and safety, and insurance purposesI knowingly, voluntarily and expressly, waive any claim I might have against Marilyn Khan and Zumba® fitness, LLC for injury or damages that I may sustain as a result of participating in the program. I, my heirs or representatives forever release waive, discharge and covenant to sue Marilyn Khan and/or Zumba® fitness for any injury or death caused by the negligence or other acts.I have read the above waiver and release of liability and fully understand its content. My signature above also acknowledges my agreement that I may be recorded and/or photographed during the activity or event, and Marilyn Khan will let me know ahead. *
Required
Do you understand all the risk that come with dance/fitness? Like injury ect. *
Media collected of me during classes *
I sign and Agree that I have read and answered all the above question truthfully *
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Do you understand by not having your webcam on you waive all your rights to claim anything with me and my insurance company? *
Do you have chest pain when performing physical activity?Please speak to your gp *
Please be aware that working out when your a keto-diets can be dangerous. Working out while on a keto diet is completely at your own risk! You won't be covered under my insurance or in any my pre-recorded sessions! I don't advice keto-diets. *
Required
Has your doctor ever said you have heart disease, high blood pressure or any other cardiovascular problem? *
Are you pregnant or have you given birth in the last 6 months? (If you don't want answer but you think you might be please ask your GP if you have the all clear to do so) if you choose not to say workout out will be at your own risk. *
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *
(Parent’s signature if under 18 years of age)I represent that I have legal capacity and authorise to act on behalf of the minor named herein. Parent/Guardian Full Name: ____ Phone number____ *
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