PLEASE NOTE:  If you answered YES to any of questions 1-13, you are advised to seek medical advice/approval before commencing an exercise class or consult further with your instructor. 

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By submitting this form you agree that you have been informed both verbally and in writing that if I answer YES to any of questions 1-12 of this questionnaire, you should seek medical advice/approval before commencing an exercise class.  

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If you wish to continue without such advice you do so entirely at your own risk.