CLASS Participant Info Form | Preseason Playground

PPAW Class Participant Information

Participants First name

Participants Last name

Parent or Guardian Name (if Participant under age 18)

Participants Birthday

Month

Day

Year

Phone

May we text you to communicate efficiently?

What PPAW Class are you participating in?

Please describe your (or your athletes) current level of fitness (or-for STRONG AS A MOTHER PARTICIPANTS -your fitness & exercise routine before your last pregnancy) (i.e. what type of exercises did you perform and how often?).

What are your goals for participating in this class?

Please list any previous injuries or surgeries you've had.

Please list any current or previous medical conditions that may affect your ability to exercise (i.e. Cardiovascular disease, Asthma, Diabetes, etc.)

Have you had any falls within the past year? Please describe, if so.

STRONG AS A MOTHER PARTICIPANTS: How many pregnancies and deliveries have you had? Please list all of the dates of your deliveries and if they were vaginal or c-section.

STRONG AS A MOTHER PARTICIPANTS: Have you had any complications with any of your pregnancies or deliveries?

STRONG AS A MOTHER PARTICIPANTS: Will you be bringing any children to class? Please list how many (max of 2 per mom), their names and ages.

PRESEASON SUMMER ACADEMY & PRESEASON SPRING TRACK PARTICIPANTS: Please list what sports you participate in, and your positions and/or events within these sports.

Please list any additional information our staff should know about you.

I grant Preseason Playground and Wellness, LLC permission to use my (or my child's) photo/video on all social media & other publications. I understand that it may be edited, copied & distributed, & I will not receive monetary compensation for its use.

I attest that the information listed above is true to the best of my knowledge. Participant or Parent/Guardian Signature (if under age 18) Below.

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