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Client Intake & Waiver Form

Please complete this form to begin your prenatal or postnatal fitness journey with us

Date of Birth
Month
Day
Year

Health & Pregnancy Information

Current Stage
Prenatal
Postnatal
Planning Pregnancy

Medical Background

Please check any that apply:

Waiver of Liability & Consent

I understand that participation in physical exercise and wellness programs, including prenatal and postnatal fitness, involves inherent risks. I affirm that I have obtained medical clearance from my physician and that I am voluntarily participating at my own risk. I release and hold harmless Bloom Prenatal Fitness and Jaimee Harris from any liability, injury, or damages arising from participation in these programs, whether conducted in person or online.

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Date
Month
Day
Year
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