Postpartum Movement Class Intake Form

Postpartum Movement Class
Intake Form

Please take a moment to fill out the form.

First Name

Last Name

Babies Name

Cell Phone Number

Birthday

How far postpartum are you?

Vaginal or C-Section Birth

YES I have been medically cleared for exercise

NO I have been medically cleared for exercise

Tell me if you have any postpartum symptoms. Incontinance, back pain, etc.

Do you have any medical conditions? Are you on medication?

Terms & Conditions

1. If anything changes with your health medically you must let the instructor know. If you cannot medically attend, a credit or refund will be applied.

2. Please do not come to class if you or baby is sick.

3. If instructor cancels class, you will be refunded or a credit will be applied to your account.

4. If you need to cancel a class, please provide 24 hrs notice. A credit will be applied to your account.

5. If you do not provide 24 hrs cancellation there will NOT be a credit or refund processed. A refund or credit will only be applied if you or baby is sick or there is a life emergency.

6. Attendees will be invoiced monthly, based on how many sessions are in the month. You will be emailed an invoice the week before the next month of classes start.

7. If you do not want to continue after you have completed a month(s), please let the instructor know.

8. Instructor is not liable for injury. The instructor is not providing medical advice or diagnosing medical conditions. This is strictly a movement class based on the certifications and scop or practice of instructor. If you feel you need medical advice, please go see the appropriate medical professional.

I agree to the terms & conditions

Thanks for submitting!