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Coach Nicola

First Name *

Last Name *

Phone

Your E-Mail Address *

Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Heat 12 - 2 monthly instalments	x £36.00	£36.00 per month for 2 months (£72.00 total)
Total: £36.00	Coupon:

I commit to completing a screening questionnaire before commencing any programmes with Coach Nicola whereby I will fully disclose my relevant medical and health history. If either of us are still in any doubt about my ability to take part thereafter, I will seek medical advice from a healthcare professional. I also commit to updating Nicola should there be any changes to the information I have provided. I acknowledge that I am undertaking this service entirely at my own risk and that Nicola Cowee / Coach Nicola shall not be liable in any way for injury or loss that might occur as a result.