Questionnaire and Liability

Y N   Has your doctor ever said that you should only do physical activities recommended by a doctor?

Y N   Has your doctor ever said that you have a heart conditions?

Y N   Do you take medications on a regular basis?

Y N   Is your doctor currently prescribing drugs for your blood pressure or heart condition?

Y N   Do you lose balance due to dizziness or do you ever lose consciousness?

Y N   Do you have a bone or joint problem?

I hereby affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit my participation in this excercise program. I understand the result of any fitness program cannot be guaranteed and my progress depends on my effort and cooperation in and outside of the sessions. I fully understand that I may injure myself as a result of my participation in FitnessBallet exercise program and I hereby release FitnessBallet from any liability.