New Member Health Waiver

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To register at our studio please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth

Has your Doctor confirmed that it is safe for you to participate in this program/class?

No

Yes

Have you lost your consciousness in the last past 12 months?

No

Yes

Initials

Today's Date

Medical conditions:

I agree to the terms & conditions

I declare that the info I’ve provided is accurate & complete

Your Signature

Thanks for submitting!

0422 871 355

Byron School:

Beachcomber Drive, Byron Bay, 2481, NSW