Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Cell Number *ID Number or Passport Number *Address Emergency Contact Name *FirstLastEmergency Contact Cell Number *Please select your course below. Kindly take note of the dates and times. *Level 1 and 2 Wednesdays 19:00 – 20:00 05 February to 05 March – R 680.00Transfer/Payment Policy *I confirmI UNDERSTAND THAT THIS 5 WEEK COURSE IS BOOKED AND PAYABLE IN ADVANCE. I KNOW I CANNOT TRANSFER TO ANOTHER CLASS OR GET A REFUND IF I CAN’T ATTEND ANY PART OF THE COURSE. Safety Agreement *I confirmI CONFIRM THAT IF I FEEL UNCOMFORTABLE PERFORMING AN EXERCISE, I WILL DISCUSS IT WITH MY INSTRUCTOR. IF I FEEL UNWELL OR EXPERIENCE ANY PAIN, I WILL STOP THE EXERCISE. Medical Clearance *I confirmI UNDERSTAND THAT IF I HAVE ANY MEDICAL CONDITION OR INJURY, I MUST GET CLEARANCE FROM MY GENERAL PRACTITIONER TO DO EXERCISE. I MUST SUBMIT THE CLEARANCE LETTER AND THE NECESSARY INFORMATION TO MY INSTRUCTOR BEFORE I COMMENCE TRAINING. COVID-19 Test *I confirmI CONFIRM THAT IF I HAVE BEEN TESTED FOR COVID-19 IN THE LAST 14 DAYS THE TEST RESULT WAS NEGATIVE. Do you have any of the following symptoms: Fever, cough, sore throat, aches, pains, headache, shortness of breath, chest pains?NoYesDo you feel pain in your chest when you perform physical activity?NoYesDo you lose balance because of dizziness, or do you ever lose consciousness?NoYesDo you have a muscle, nerve, bone or joint problem?NoYesAre you pregnant?NoYesDo you smoke?NoYesHave you ever had any surgeries, injuries or chronic pain?NoYesAre you currently taking any medication?NoYesDo you have any vision or hearing problems?NoYesHas a medical doctor ever ever diagnosed you with a chronic disease?NoYesDo you know of any other health-related reason why you should not engage in physical activity?NoYesDetails on physical/medical conditions or medicationPlease give detail if you have answered yes to any of the above. Declaration *I confirmI CONFIRM TO THE BEST OF MY KNOWLEDGE THAT ALL INFORMATION DISCLOSED IS CORRECT AT THE TIME OF COMPLETION. I CONFIRM THAT I WILL INFORM THE LYRA PROJECT SHOULD I BE DIAGNOSED WITH ANY CONTAGIOUS ILLNESS SO AS TO FACILITATE CONTACT TRACING. EmailSubmit