Name *
Your D.O.B *
Your D.O.B
Baby's Name *
Baby's Name
Baby's D.O.B *
Baby's D.O.B
Today's Date *
Today's Date
Address *
Mobile Number *
Mobile Number
In case of emergency
Please tick if you have experienced any of the following during or after pregnancy *
e.g. hypermobility, back operation, prolapse, cancer, major surgery, IVF?
If so please give details
Antenatal Clients Only
Postnatal clients only
I can confirm that I have had the all clear/6 week check with my GP to commence suitable postnatal exercise. I am aware I must feel well prior to each class and will notify you (the trainer) should I feel unwell during the class. Whilst I am aware that every effort has been taken to ensure this exercise class is suitable for ante and post natal women, I understand that my participation and the safety of both my child/children and myself are my responsibility. *
Data Protection: The information you provide will be used for Buggyfit purposes only, by your instructor and will not be shared with any third party without your prior permission. *