Pre-experience intake

Health & Consent Form

To ensure your safety and comfort, please complete this form before your session. All information is kept strictly confidential and used solely to personalise your experience.

01 — Consent & acknowledgements

I understand that this session may be photographed or filmed for SIRÈNE CLUB's use, and I consent to my likeness being captured in group settings. I may request to opt out at any time by notifying the facilitator.

I confirm that the health information I have provided below is accurate to the best of my knowledge. I understand that SIRÈNE CLUB is not a medical provider, and I take personal responsibility for my participation. I will inform the facilitator of any changes to my health before the session begins.

I have read and agree to the SIRÈNE CLUB Terms of Use and Privacy Policy.

02 — Health & allergies

Allergies (food, environmental, topical)

Medical conditions or injuries

Current medications

Pregnancy or recent surgery / procedure

03 — Emergency contact

Full name *

Phone number *

Relationship

04 — Anything else we should know

Special requests or notes

Why we ask

Your wellbeing is our priority. This information allows our facilitators to adapt the session to your needs, ensure your safety, and provide the most personalised experience possible.

Confidentiality

All information shared here is strictly confidential. It is accessible only to your session facilitator and is never shared with third parties.

Questions?

If you have any concerns about completing this form, please reach out before your session.

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