kids’ registration form Your Child's Name * How does your child like to be called? First Name Last Name Email * Mobile * This number may be used to contact you about your booked classes. Address Address 1 Address 2 City State/Province Zip/Postal Code Country Your Child's Date of Birth * Month/Date/Year MM DD YYYY Your Child's GP's Name & Address * Address 1 Address 2 City State/Province Zip/Postal Code Country How did you hear about Beyond Move? What prompted you to take up Children classes with Beyond Move? What would your child like to focus on? Please select all answers that apply to you. Core Stability Flexibility Posture Hypermobile joints Relaxation Toning Stretching Other What are the 3 main aims hoping to achieve? Does your child have any communication problem? * Please give us details Does your child has any back deformities or postural issues? Any hypermobile joints? If so, please provide brief details below. * Are your child involved in any other sports or physical activities? If so, please provide brief details below. Has your child's GP agreed for you to carry out gentle exercises? * Yes No Are your child currently experiencing, or have you ever been diagnosed with any of the following medical conditions? * Please select all answers that apply to you. Back pain Pain at the back or front of the Pelvis Any other Muscular or Joint Conditions Heart Problems High or Low Blood Pressure Blood Circulation Issues Diabetes Anaemia Epilepsy None of the above If you checked any of the options in the previous question, please provide further details. Does your child has any allergies? * Please provide detailed action plan in case of an allergic reaction. Have your child had any recent injuries or surgery? If yes, please provide details. * Class participation informed consent I have answered these questions to the best of my belief. I will inform my child's teacher if my child's medical condition changes in the future * Yes Emergency Contact Name * First Name Last Name Emergency Contact Phone Number * (###) ### #### Date of registration * MM DD YYYY Thank you! Please get in touch if you need to discuss anything further.Our email is hello@beyondmove.com or call us on 07870 667 384
