Sign up form

1Personal profile

2Goals

3About you

4Health Questionnaire

5Membership

6Kangatraining

7Agreement

Just a few questions to help inform programming for your sessions
Name*
First Last
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Date of birth*
Emergency contact*
First Last
Emergency contact phone*
Your occupation

All our mums n bubs training sessions are safe, gentle, low impact, fun fitness class for mums and bubs. It is specifically designed for postnatal women and is the ultimate workout. We focus on rebuilding your entire body after pregnancy, through a fun & energetic class. Babies can be worn in carriers as mums work up a sweat or can be snuggled by one of our onsite carers giving you a break.
Baby/child's name attending dance class*
Baby/Child's date of birth
Most recent type of birth*
- Vaginal – unassisted
- Vaginal – assisted
- Caesarean
- n/a
Date of postnatal 6 week check-up*
DD slash MM slash YYYY
Were you cleared to begin physical exercise at that appointment or by a women's health physiotherapist?
- Yes
- No
Does your baby have any contraindications to being in a baby carrier (for example, lack of head control or neurological issues)?
Does your baby suffer from Hip Dysplasia?*
- Yes
- No
If yes, please specify details below.
Does your baby have any medical conditions your trainer should be aware of? If so, please detail:
Do you own a baby carrier? If yes, what type?*
Have you experienced any problems using a baby carrier? If so, please detail:
Is there anything else you believe your trainer should be aware of?

Do you have any other conditions or concerns not identified in this questionaire?
Information supplied*
I agree
I acknowledge that to the best of my knowledge all the information I have supplied in this form is true and correct.
Agreement for participating in exercise*
I agree
I hereby understand and acknowledge that the training, programs and activities provided by Playground Training may expose me and/or my child to inherent risks including, but not limited to; accidents, injury, illness and death.

I assume all risk of injuries associated with the participation including, but not limited to, falls, contact with other participants, use and hire of baby carriers, the effects of weather including heath and/or humidity, and all other such risks being known and appreciated by me.

I acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with my own, or my child’s, participation in the activity.

I acknowledge that I am physically fit and mentally capable of performing the physical activity I choose to participate in.

I confirm that if I am pregnant I have received written consent from my doctor that I am able to participate in chosen activity.

I confirm that where I have hired a baby carrier, that my child does not exceed the manufacturer’s recommended weight of 20kg.

After having read this waiver and knowing these facts, and in consideration of acceptable of my participation and Playground Training furnishing services to me, I agree, for myself and anyone entitled to act on my behalf to indemnify and to keep indemnified, Playground Training its servants, and each of them against all actions, costs, claims, charges, expenses, penalties, demands and damages whatsoever which may be bought or made by me or on my behalf.

I undertake to indemnify and hold harmless and free, Playground Training, from any and all claims of whatsoever nature or cause (including negligence) and however arising, which may be made by myself or anyone else on my behalf who suffer any damages (including but not limited to damages arising from or related to personal injury, death and/or loss of support) of whatsoever nature.

I agree to comply with all the rules, regulations and instructions in relation to the chosen activity.

I have read and understood the content and important consequences of this document and acknowledge that I am bound thereby.
Privacy Statement*
I agree
The personal information contained in this document is to provide contact information and medical details for individuals wishing to undertaking exercise/activity with Playground Training. This information may be disclosed to medical practitioners or designated third parties should there by an issue or emergency, and in accordance with the Information Privacy Act 2009 (Qld) and The Privacy and Personal Information Protection Act 1998 (NSW) and Privacy Act 1998 (WA) and Information Act 2002 (NT) and Freedom of Information Act 1982 (Vic) and in compliance with the Information privacy principles established by the South Australian Privacy Committee.