Your Name: *


Your Email: *


DOB *


Address *


Do you currently do any exercise, if so what


Have you done any exercise/sport in the past, and if so what?


Do you suffer any joint problems?

Have you high or low blood pressure?

Are you on medication?

Do you have any heart conditions, chest pains or problems?

Do you have diabetes or any other metabolic disorder?

Do you suffer shortness in breathe or dizziness?

Do you struggle with back or neck pain?

Have you given birth in the last 12 months?

Have you had any operations?

Do you have any breathing problems?

If you have ticked any of the above, please give details


Anything else you wish to add?


We recommend your wear suitable, supportive trainers, and wear breathable clothing. Make sure you drink plenty of water. If you are feeling unwell, or very tired I suggest you consider taking a rest day. Activewoman is made up of qualified and insured individuals All the information and exercises given within the classes/sessions is to be used as a guideline to develop your fitness and wellbeing. Activewoman holds no responsibility for the interpretation of the advice given during or after the sessions. Should you suffer any illness, injury or loss during the sessions Activewoman will not be held responsible. If any of the given information changes, I will inform Carys immediately. Please tick to agree *