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Health Screen & Waiver Form

Welcome to Modern Day Mantra! Our vision and mission is to ignite you through Movement, Mindset and Meaning where you can overcome your physical, mental and emotional barriers, face life's challenges head on and unleash your full potential.


Before we start, please kindly read the following information and fill out the below form. If you have any further questions or concerns, please discuss this with us prior to your session.


If your circumstances do change at any point during your time with us, it is important to let us know so we can continue to cater towards your needs and well-being.


We look forward to you starting your journey with us and being your guiding support along the way!


Date of birth
Day
Month
Year
Do you have or ever had (please tick those that apply): In order to be involved in our programs with us, please answer honestly to all of the below health questions. This is to ensure we can assist in the safest way possible.
If you have ticked any of the above, you need a signed medical clearance from you GP before starting our programs. OR I warrant that I am physically and mentally well enough to proceed with starting the program.
Yes, I obtained signed medical clearance from my GP and have emailed hello@moderndaymantra.com.au
Yes, I self-clear myself of the above conditions

I, being aware of my own health and physical condition am voluntarily participating in any said activities by Modern Day Mantra.

Having such knowledge, I hereby acknowledge this release, any representatives, agents and successors from liability for accidental injury or illness which I may incur as a result of participating in the said activity. I hereby assume all risks connected there with and consent to participate in the said program.

I agree to disclose any physical limitations, disabilities, ailments or impairments which may affect my ability to participate in the said program, now, and at any point during my time with Modern Day Mantra.

In the event that medical clearance must be obtained before my participation, I agree to contact the GP and obtain written permission prior to the commencement of the program and that the permission be given to the practitioner.

I am ok with the occasional use of pictures, videos or the like for potential marketing material and social media.

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