Mummylicious Love Your Body Registration Form

Disclaimer:  Please read carefully. By completing and submitting this Mummylicious Fitness PAR-Q Registration form, you are confirming you have read and agreed to the disclaimer of training. All completed questionnaires will be kept confidential and not shared with any third parties.

You should always consult your physician or healthcare provider before changing your diet or starting an exercise program.

I understand that there is a risk of injury associated with participating in any exercise program run by Mummylicious Fitness. I have answered all questions truthfully and to the best of my knowledge and I will inform the instructor of any change in my health,

I hereby assume full responsibility for any and all injuries, losses and damages that I incur while attending, exercising or participating in any of Mummylicious Fitness sessions. I hereby waive all claims against Mummylicious Fitness, its instructors, or partners individually or otherwise, for any and all injuries, claims or damages that I might incur.
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Full Name: *
Email Address: *
Address: *
Phone Number: *
Emergency Contact Name & Number: *
Who should we contact if you become ill or injured?
How did you hear about us? *
Who should we contact if you become ill or injured?
Please provide the full name of your referral or the locations where you found our info - we'd love to thank them!
Your Occupation:
Your Doctor Name & Number:
Height: *
Current Weight: *
Goal Weight or Size: *
Do you suffer from any of the following? *
Required
Do you have abdominal separation of more than 2 cm? *
Required
If you so how many cm of separation?
Are you pregnant or trying to conceive? *
Are you over 45 yrs and unaccustomed to exercise? *
Do you have any allergies or phobias? *
Are you a smoker? *
Have you given birth in the last 6 weeks? *
Are you taking any medication that your instructor should be aware of? *
Is there any other reason why you should not participate in physical activity? *
Do you have any injuries or problems that might restrict your participation in an exercise program? *
If you have answered yes to any of the above please give details? *
What is your main goal/goals? *
Required
How many times per week do you currently exercise and what type? *
What type of exercise do you enjoy? *
What activity intensity level do you prefer? *
Are you at least 6 weeks postnatal or 8 weeks if you had cesarean? *
Terms & Conditions *
IMPORTANT: Please read these terms carefully. It is a condition of your use of our services that you comply with these terms and conditions.These terms and conditions apply to all goods or services (“MF Membership”) supplied by Mummylicious Fitness (MF). They are to be read in addition to and will prevail over any additional terms and conditions specified for any individual purchase of MF Memberships supplied by MF. In so enrolling and in consideration of my application fee for entry to any MF Membership, I acknowledge, warrant and agree that: 1. Interpretation: • MF means Mummylicious Fitness ABN 68 709 415 254 and its permitted successors and assigns.• Agreement means this document, the attached Enrolment Form as well as any schedule or annexure to this document.• Representative means any of MF's directors, officers, contractors, sub contractors, servants, agents or other representatives.2. Payment: • All fees (unless paid in full), MF Memberships and availability of MF Memberships are subject to change without notice.• Setting up of automatic weekly payment of fees is required in advance for all MF Memberships and is the mechanism for securing my place in a MF Membership.  • Pro-rata payments for some MF Memberships can be arranged on application.3. Refund: • Where I have given MF at least 10 business days prior written notice of my intention to withdraw from a MF Membership, I am entitled to terminate my membership. • Where the relevant MF Membership has not commenced and where I have given MF 2 business days prior written notice of my intention to withdraw from a MF Membership, I am entitled to a cancellation with no fee. • Once a MF Membership has commenced, I am not entitled to a refund or credit for sessions completed. 4. MF’s Rights: MF may:• Vary the delivery of a MF Membership at anytime without notice.• Cancel or postpone a MF class up to 24 hours prior to the commencement of that MF class. Where a MF class is cancelled by MF, I will be offered the choice of rebooking an alternate class within 4 weeks. • Refuse my entry or continuation to a MF Membership if MF’s Representatives have deemed (at their sole discretion) me not to be medically or physically fit to participate. However, MF is not able to provide advice concerning medical fitness to undertake any exercise or activity and that it is my responsibility to seek medical advice in this regard.  • Refuse my entry or continuation in a MF Membership if MF’s Representatives have deemed (at their sole discretion) my behaviour to be unacceptable, unsafe or inappropriate. 5. Warning: Participation in a MF Membership can be inherently dangerous. Accidents may happen which may result in me  being injured or even killed. I agree to release indemnify and hold harmless MF from any liability, demands, proceedings or other claims for injuries (including death) or any health problem suffered by myself or my child, howsoever sustained as a result directly or indirectly of our participation in any physical activities or the resulting exercise program.  I have read and understood this warning and voluntarily accept and assume the inherent risks in participating in each relevant MF Membership.  6. Fitness to Participate: I am and will continue to be medically and physically fit and able to participate in the Membership. I am not and will not be a danger to others or myself. I will immediately notify MF in writing of any change to my fitness and ability to participate.  Unless I notify MF otherwise, I understand and accept that MF will continue to rely upon this declaration as evidence of my fitness and ability to participate.  7. Medical Treatment: I consent and authorise MF and its Representatives to administer or obtain medical assistance in the event of an accident or medical condition I may suffer whilst participating in a MF Membership and agree to pay for any costs or expenses incurred by MF in administering or obtaining such medical assistance.8. Exclusion of Liability: To the extent permitted by law and while all reasonable care is taken, MF and its Representatives cannot be held responsible and excludes all liability however arising (including liability for negligence) for direct, indirect or consequential loss, damage, injury, cost and expenses (including without limitation loss of revenue or profits, loss of business opportunity, goodwill and/or data, and failure to realise anticipated savings or benefits).9. Release and Indemnity: To the extent permitted by law, I release and indemnify, and will keep indemnified, MF and all of their Representatives in relation to all claims which I now, or at any time in the future may have against MF, arising from or related in any way to the supply and my participation in MF Memberships.10. Privacy: I understand that the information I have provided is necessary for my participation in any MF Membership. I acknowledge and agree that the information will only be used by MF to facilitate the conduct of MF Memberships. As part of my enrolment with MF, I acknowledge that I may receive information from time to time about the products and services offered by MF. If I do not wish to receive such information from MF, I will notify MF in writing.11. Photographs and right to use: Photos may be taken and used by MF for promotional purposes, without payment or compensation to me. Such photos are and will remain the property of MF.12. Assignment: MF may assign or otherwise deal with this Agreement at its sole discretion. I cannot assign any rights under any agreement with MF without prior written consent of MF (which may not be unreasonably refused).13. Severability:  If anything in this Agreement is unenforceable, illegal or void then it is severed and the rest of this Agreement remains in force.14. This Agreement cannot be amended. If I do amend it my application will be null and void and cannot be accepted by MF.15. I have provided the information required overleaf and signed the form. I warrant that all information provided is true and correct. I have read, understood, acknowledge and agree to the above declaration including the warning, exclusion of liability, release and indemnity.
Required
I understand that I submitting this form registers me for the Mummylicious 10 Week Love Your Body Challenge beginning July 2020 *
Required
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