Register for Free Exercise Class in Burwood Park Friday 27 May 2022

Mood Active is running a free exercise session in Burwood Park on Friday 27 May 10.15-11am.

The session will contain bodyweight exercises focussed on getting your heart rate up to 50-75% of your maximum capacity, using strength and cardio moves.
Meet at the Community Centre Pavilion, Burwood Park, 2B Comer St, Burwood NSW 2134.
It is an indoor undercover space so no worries if it's raining.

Suitable for people 16-70 who can participate in light exercise standing up. You must register before attending.

You will receive a reminder email the week before the class to confirm your registration and attendance.

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* What is your first and last name?

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* What is your phone number?

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* What is your email address?

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* What is your age?

Under 18

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* What is your gender?

Male

Female

Other

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* What Council area do you live in?

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* Which of the following categories best describes your employment status?'

Unemployed

Employed and earning more than $65k a year

Employed and earning less than $65k a year

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* Do you identify as a person with a disability?

Yes

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* To check it is safe for you to participate in our exercise class, please review the below carefully and check the box if your response is Yes to any of the questions below:

Has your medical practitioner ever told you that you have a heart condition or have you ever
suffered a stroke?

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical
activity/exercise?

Do you ever feel faint, dizzy or lose balance during physical activity/exercise?

Have you had an asthma attack requiring immediate medical attention at any time over the
last 12 months?

Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?

If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose)
in the last 3 months?

Do you have any other conditions that may require special consideration for you to exercise?

None of the above.

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* If you answered Yes to any of the questions above, please seek guidance from an appropriate
allied health professional or medical practitioner prior to undertaking exercise.

I understand

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* Please provide your emergency contact details

Emergency contact name

Emergency contact number

Relationship to you

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* By typing your first and last name below, you agree that in accessing Mood Active’s services, I affirm that my physical health is good and I do not have any disability, injury, illness or condition that would be adversely impacted by the exercise service. I affirm I can perform exercise of a moderate nature and I am not currently under the care of a physician. If under the care of a physician, I have received his/her permission to participate in moderate exercise at Mood Active.

Release and Waiver: I hereby accept all risks to my health and of my injury or death that may result from participation in Mood Active services and I release Mood Active and its employees and representatives from any liability to me, my personal representatives, estate, heir, next of kin and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my use of Mood Active services, whether caused by negligence of the company, employees, or representatives or otherwise. I agree to release and hold harmless Mood Active and its employees from all liability which may result from my use of the Mood Active services.

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* What is your first and last name?

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* What is your phone number?

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* What is your email address?

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* What is your age?

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* What is your gender?

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* What Council area do you live in?

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* Which of the following categories best describes your employment status?'

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* Do you identify as a person with a disability?

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* To check it is safe for you to participate in our exercise class, please review the below carefully and check the box if your response is Yes to any of the questions below:

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* If you answered Yes to any of the questions above, please seek guidance from an appropriateallied health professional or medical practitioner prior to undertaking exercise.

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* Please provide your emergency contact details

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* If you answered Yes to any of the questions above, please seek guidance from an appropriate
allied health professional or medical practitioner prior to undertaking exercise.