Postnatal Screening Form

The information collected in this form will be used only for the purpose of understanding the level of support you require, the changes you wish to make and any health conditions that may require a modified programme designing for you and will not be disclosed to any third party without your consent.

We reserve the right to request a doctor’s clearance before allowing you to receive personal training with Amy Moore Fitness.

Please fill all of the boxes as thoroughly as possible. By giving as much information as possible a detailed plan / programme can be developed and options discussed.

Please fill out the form as thoroughly as possible and I will be in touch! Please email [email protected] if you have any questions.

Contact Information

Personal Information

Medical Information

Medical Information #2

Medical Information #3

Terms & Conditions

Informed consent and Waiver *

I hereby state that I have read understood and answered honestly the screening questionnaire.
During the exercise programme, every effort is made to keep the class / session safe and minimise the risks whilst providing an effective session. I am participating of my own free will and I am aware, as with any exercise programme, there is a risk of injury. I agree to participate in the exercise programme described to me by Amy Moore .I understand that in order for the session to remain safe, alternatives and adaptations will be made throughout. The structure, purpose, benefits and risks of the session will be explained throughout the class, and I understand that I may withdraw from the session at any time.
I understand it is my responsibility to inform Amy Moore if any physical / Medical changes occur which may prevent me from exercising safely.
If at any time you feel undue pain or excessive discomfort, Stop the activity and inform instructor.
I understand that from time to time photographs will be taken for advertising and promotion, and i agree to have any pictures of me used in this way. I will not hold Amy Moore liable in any way for injuries or illness that may occur while I am training.

COVID -19 By ticking this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you may be exposed to or infected by COVID-19 by attending Amy Moore Fitness and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Amy Moore Fitness may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Amy Moore Fitness employees, volunteers, and programme participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at Amy Moore Fitness. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Amy Moore Fitness employees, Freelance instructors and self-employed personal trainers, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Amy Moore Fitness, its employees, Freelance instructors and self-employed personal trainers agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Amy Moore Fitness programme.

Terms and conditions

By ticking I have read and agree to the terms and conditions available in the footer of this webpage