Book Kangatraining Trial

Which location are you interested in? *

Name *

First

Last

Email *

Phone *

Date of Birth *

Baby's Name *

Baby's DOB *

Emergency Contact Name & Relation *

Emergency Contact Phone *

Waiver *

I have read and agree to the terms

In consideration of my participation in the Activities or any part thereof, I, the undersigned, hereby confirm that:
1. I understand and acknowledge that the Activities may expose me and/or my child to inherent risks including, but not limited to, accidents, injury, illness and death.
2. I acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with my own, or my child’s, participation in the Activities. I have no reason to believe that my physical condition, or the physical condition of my child, is incompatible with participating in the Activities. I confirm that if I am pregnant, I have received written consent from my doctor that I am able to participate in the activities. I confirm that where I have hired a baby carrier, that my child does not exceed the manufacturer’s recommended weight for that carrier.
3. I affirm and acknowledge that I have been fully informed of the inherent risk of injuries, dangers, and hazards associated with participation in the Activities. I hereby assume all such risk of injuries, dangers, and hazards associated with participation in the Activities, including, but not limited to, falls, contact with other participants, use and hire of baby carriers, the effects of weather including heath and/or humidity, my own negligence or the negligence of others, and loss of balance or physical coordination.
4. I hereby waive any and all claims or actions I or my child have or may have in the future against Kangatraining, Nicole Mansfield, their owners, principals, employees, contractors, agents and volunteers (the “Releasees”) AND HEREBY RELEASE the Releasees from any and all liability, claims, or actions for any loss, damage, expense, injury, illness or death that I or my child may suffer as a direct or indirect result of or related to in any way my participation in the Activities.
5. I agree to indemnify and hold harmless the Releasees from any and all liability for any loss, damage, expense, injury, illness or death to any third party resulting from my and my child’s participation in the Activities.
6. I agree this release and indemnity shall be effective and binding upon my heirs, next of kin, executors, administrators and assigns.
7. This Consent and Waiver and any rights, duties and obligations as between the parties to this Consent and Waiver shall be governed by and interpreted solely in accordance with the laws of the Province of British Columbia.
By signing this Consent and Waiver, I acknowledge that I have read and understood its content and important consequences and I agree to be bound by its terms. I further acknowledge that I sign this Consent and Waiver voluntarily and that I am at least nineteen years of age.

How did you hear about Kangatraining?

Most recent type of birth *

Caesarian
Vaginal
Assisted

Have you had your 6 week checkup? *

Yes
No

Have you been cleared for exercise by your healthcare provider? *

Yes
No

Are you currently taking any medication? *

Are you currently pregnant? *

Yes
No
Maybe

Do you have a heart condition, or have you ever suffered a stroke? *

Yes
No

Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance? *

Yes
No

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

Yes
No

.Do you have diabetes (type one or type two)? If yes, have you had trouble controlling your blood glucose in the last three months? *

Yes
No

Please tick if you've experienced any of the following:

Do you have any of the following (tick all that apply):

Allergies to grass/pollen/pollution
Reactions to insect bites
Heat exhaustion/stroke
Anxiety about exercising in public

Does your baby have any medical conditions we should be aware of?

Does your baby have hip dysplasia? *

Yes
No

Do you own a baby carrier? *

Yes
No

If so, what type will you be bringing? *

Would you like to borrow a carrier for this class?

Yes
No

What are two songs that get you moving?

I have read and agree to the Kangatraining terms and conditions and privacy policy *

Yes

Kangatraining terms and conditions

Privacy Policy

Photo release *

I have read and agree to the terms below
I would prefer to not be in photos.

I understand that the Activities may be filmed, photographed, or recorded and by signing above I agree to allow any photos, videos, or other likeness of myself or my child to be used for promotional and publicity purposes by the releasees.