top of page

Class participation form.

Please complete the form before your first class with Empower with Elise.

Empower with Elise logo
Has your doctor ever said that you have a bone or joint problem, such as arthritis, or any medical condition, surgical operation or injury that has been aggravated by physical activity or might be made worse with exercise?
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Have you ever felt pain in your chest when you do physical activity or at rest? Do you often feel faint, have spells of severe dizziness or have you ever lost consciousness ?
Do you know of any other reason why you should not participate in a programme of physical activity? Or any reason why your participation may be limited during class?

Thanks for submitting!

bottom of page