Tanja London

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Heart Disease

yes

no

Asthma or other respiratory ailment?

yes

no

High Blood Pressure

yes

no

Stroke

yes

no

miscarriage

yes

no

Osteoporosis

yes

no

Kidney Disease

yes

no

Diabetes

yes

no

Low Blood Pressure

yes

no

Vascular Disorders

yes

no

Depression

yes

no

Arthritis

Rheumatoid

Osteo

no

Name *

Emergency Contact

First Name

Last Name

Phone *

(###)

###

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I understand that it is important to BOOK AND CANCEL a minimum of 24h before. Sessions are otherwise not held or not refunded. In general, the sessions are not transferable and each package purchased has a specific expiry date. I understand that different studios have different policies and will adhere to their safety and general policies as well as COVID protocols. I understand that if I am later than 10 minutes to a group class that I cannot take part as for my owns health's sake. If I am late for a private session I understand that the instructor is not obliged to make up for that time. *

I have read and agree to the above policies.

I will book a minimum of 24h via email or text - t.london@me.com or (603) 244-9439.

I will cancel a minimum of 24h via text message - (603) 244-9439.

I consent that the above information is correct and understand that it will remain confidential. Should there be any change in my condition or medication, I shall inform Tanja London accordingly and prior to class. I understand that if I have not participated in an exercise program for some time or have any underlying condition, I should consult my medical practitioners before I begin. I understand that exercise may cause injury and accept the risk and responsibility be it in the studio or online. I will inform Tanja London and stop immediately should I feel dizziness, nauseousness, pain or any feeling that may suggest any exercise is problematic at that time. In the unlikely event of me becoming unconscious, I give permission for Tanja London to arrange medical treatment for me at the listed hospital. I agree not to attend class while having COVID 19 symptoms or am under the influence of recreational drugs or alcohol. *

I consent.

I have read and accept the conditions of this agreement.

Would you like to be on my mailing list? *

YES

NO