FYSM Intake

Location / Time zone

Do you have any previous physical activity experience?

Beginner

Some experience

Returning after a break

Do you have specific goals for your practice?

Select up to 3 goals:

Other goals

1. HEART CONDITIONS Has a healthcare provider ever told you that you have a heart condition, or that you should participate in physical activity only under medical supervision?

Yes

No

2. SYMPTOMS DURING EXERCISE Do you experience chest pain, unexplained shortness of breath, fainting, or dizziness during physical activity?

Yes

No

3. BLOOD PRESSURE Do you have uncontrolled high blood pressure, or are you taking medications that affect heart rate or blood pressure?

Yes

No

4. PREGNANCY (if applicable) Are you planning pregnancy, currently pregnant, or have you given birth recently?

Yes

No

5. INJURIES OR SURGERIES Have you had any recent surgeries, injuries, or conditions (e.g. spinal disc problems, serious wrist, shoulder, or knee injuries)?

Yes

No

6. OTHER CONDITIONS Do you have any other medical conditions that may affect your ability to exercise safely (e.g. glaucoma, balance disorders, dizziness, hernia, diastasis recti, nephroptosis)?

Yes

No

Doctor’s Clearance

Since you indicated certain health limitations, a medical clearance is required before participation.

I have a doctor’s approval to participate with modifications

I prefer not to participate at this time

Please specify which condition from question #6 applies to you.

Informed Consent and Risk Acceptance

I consciously agree to listen to my body, choose appropriate exercise variations, and stop the session if I feel pain, dizziness, or any other discomfort. I understand that these classes are designed to improve overall fitness and wellbeing, but do not constitute medical care.

Online Environment

I will select intensity levels that suit my abilities. If I experience pain — I will stop. I will ensure that my practice space is clean, stable, and free of obstacles, and I accept all risks related to my environment, equipment, and internet connection. I understand that the instructor may not always see every participant on Zoom or provide real-time corrections.

Waiver of Claims

I acknowledge and accept that I participate in the classes at my own risk and will not hold the instructor or studio liable for unintentional errors or ordinary negligence related to in-person or online sessions.

Health Condition

I confirm that I am able to safely participate in physical activity ranging from light to intense, or have received approval from a qualified medical professional. I agree to inform the instructor if my health condition changes.

Electronic Documents

I consent to the use of electronic documents and signatures.