Terms and Conditions

Please complete this form as accurately as possible.

 

If you have any questions please ask a Cycology Club team member for assisstance.

 

If you are under the age of sixteen (16) years, a parent or guardian must complete and sign this form on your behalf.

 

Full Name:

Date or Month of Birth:

Mobile:

Email:

Phone:

 

Please read carefully and indicate YES if you have any of the following:

Contagious Disease

Ailments

Physical injuries

Diabetes

Osteporosis

High Blood Pressure

High Cholesterol

Arthritis

Anorexia

Anaemia

Epilepsy

Respiratory Ailments

Back Problems

 

 

 

 

2. If you have ever been diagnosed with any of the following please indicate YES:

 

Heart Condition

Stroke

Asthma

Hypoglycaemia

 

3. Are you aware of any disability or impairment that would make attending a Cycology Club class hazardous or detrimental to your health, safety and/or wellbeinng? 

 

4. Do you ever have pains in your chest while performing physical activities of any kind?

 

5. Have you ever had pains in your chest while not performing any physical activity?

 

6. Have you ever lost your balance due to dizziness?

 

7. Have you ever lost consciousness?

 

8. Have you recently had surgery?

 

9. Are you currently takingmedication, either prescription or non – prescription?

 

10. If you answered yes to Question 9, are you aware whether this medication may affect your ability to exercise?

 

11. If you answered no to Question 10, have you checked with your medical practitioner?

 

If you answered YES to any of the above questions, please seek guidance and  clearance in writing from your Physician or health professional prior to undertaking any physical activity or exercise with Cycology Club.

 

Please note: Riding while affected by stimulant recreational and prescription drugs poses a significant risk of heart attack, seizures and death. By signing this waiver you agree that you will not participate in classes at Cycology Club under the influence of these drugs. By signing this waiver, you agree to notify Cycology Club if your health condition changes at any time during the period of time that you participate in Cycology Club classes. If your health condition ever presents a limitation on your physical activity level, please notify your instructor and seek their prior advice on the appropriate modifications to your session. By signing this waiver, you also agree that Cycology Club is not responsible for the loss or theft of any personal property in the studio or property surrounds including in lockers or with our concierge service. By signing this waiver, you agree that you meet the minimum height requirment of 150cm.

 

You acknowledge and confirm that you fully understand and have fully answered truthfully and to the best of your knowledge all the above questions and agree to waive and release Cycology Club from all liability for any loss, injury or death.