Enrollment Form

Body and Balance - JillHQ Enrollment Form

Personal Details

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

In Case Of Emergency Contact

Pre-Exercise Questions

While Body and Balance exercise is designed for all levels of Fitness, it is important to check with your Doctor before commencing and let the instructor know of any medical conditions. This is particularly important if you are or recently have been pregnant, injured, or ill. Please read and complete the following questionnaire carefully.

Medical Condition

Personal Waiver Statement

advise that I do not have any injuries, ailments or conditions which would prevent me from undertaking Body & Balance exercise classes and that I take this class at my own risk. If I answered yes to the Medical Conditions question above, I have sought qualified professional advice regarding my ability to participate in this class and am satisfied with that advice. I understand that Body & Balance instructors are not qualified or able to provide medical advice and I indemnify Body & Balance instructors and staff against any claim that may result from my attendance and participation at any Body & Balance classes. I understand that this information is used as a guideline to the limitations of my ability to exercise. I have answered the questions to the best of my ability.

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How did you hear of Body and Balance or JillHQ?

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