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Maka Pole & Fitness ParQ form
Health Questions
If you have ever had any of the following, please select 'yes'
  • Heart conditions or chest pain   

  • High or low blood pressure      

  • Faintness or dizzy spells

  • Asthma

  • Diabetes

  • Are you pregnant or postnatal

  • Have you had any operations in the last year

  • Any recent injuries

  • Bone or joint problems

  • Prescribed medicines or dietary supplements

  • Any other medical conditions not previously mentioned

If you have answered yes to any of the above questions, please provide further detail below. We would also recommend that you seek advice and confirmation from your doctor prior to participating in the class. 

Health Declaration

Thanks for submitting! This has now been sent to our team ready for your first class.

© 2022 Maka Pole & Fitness

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