In Home Exercise Activity Participant Agreement Form In Home Exercise Activity Participant Agreement Form This form is the agreement between yourself and the Harrow Bush Nursing Centre if you are undertaking HBNC exercise classes in your home including using a virtual platform. Please note that prior to undertaking any exercises classes through the HBNC, you must also complete and sign the Physical Activity & Exercise Indemnity Form. Considerations for your in home training: First aid – your instructor can not give you first aid, but will advise you as needed if an incident occurs. Always keep your instructor up to date with your injuries and illnesses and also your current residential address and emergency contacts. In the event of an emergency (and you are unable to physically call 000), your instructor will call 000 on your behalf giving your details of address and any medical history you have provided to us on your Physical Activity & Exercise Indemnity Form. In the case of all other injuries or illnesses, you will be instructed to call 000 yourself as this is the preferred process. Please advise your instructor if you are exercising alone in your home. If you are joining in from another place that is not your listed residence you must inform your instructor before the class starts and provide your temporary address. If you are feeling unwell during or after your session you must inform your instructor, and do not undertake the class if you are feeling unwell beforehand. Room temperature - please make sure your room is at a comfortable temperature that is not too hot or cold. Exercising in a hot room can cause heat exhaustion and can cause dehydration. Exercise area - adequate room to move. Slip and trip free flooring. Ensure adequate lighting. At home you may need to consider other family members or pets sharing your space too. Hydration – keep water with you at all times and make sure you all hydrated before exercising. Camera - if your instructor can not see you exercising they cannot instruct you. To participate in these classes you need to make sure your instructor can see you well. Education of virtual classes - there may be times where participants will be asked to be on mute to ensure all participants can hear the instructor. If at any time you need to ask a question, you can unmute to do this. Participant Consent By agreeing below I acknowledge and confirm that:- By partaking in virtual classes with the Harrow Bush Nursing Centre I understand the following: ● Physical Activity and Exercise Program Indemnity forms need to completed annually ● New clients must have a face to face consultation with the instructor. ● I have read and fully understand all the additional information that may have been provided in relation to the program and activity. ● I agree that HBNC will not incur any responsibility or liability for any accident/injury/damage to /loss of property from me during the activity. ● I authorise HBNC to obtain medical/ambulance assistance in the case of an emergency involving me. ● I understand and accept that it is my responsibility to advise HBNC of any changes to the information supplied. Name of Participant * Type in the words 'I Agree' to confirm you agree to all terms listed above. * Date * I confirm that I have also completed the Physical Activity & Exercise Indemnity Form (this form is required to to be completed annually) * Yes No If you are human, leave this field blank. Submit
