Staff Strength and Conditioning Agreement

Personal Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Emergency Contact

Name*

First NameLast Name

Relationship:*

Emergency Contact*

Area CodePhone Number

Rules of the Centre:

Beginning participants are encouraged to train with other Churchie staff members;
Participants must secure all their personal belongings;
Towels and water bottles are mandatory;
No food or drink (other than plastic water bottle) is allowed
All equipment is to be replaced after use;
Suitable footwear and attire are required, no open toe footwear;
Observe all posted signs and equipment warnings;
Safe and proper use of equipment is required at all times – do not experiment with equipment you are not familiar with;
Wipe down equipment/upholstery after use, preferably with alco wipes;
Verbal or physical abuse will not be tolerated;
Limit your time on cardio equipment to 20 minutes when others are using the gym;
If the machine you require is busy move onto another station until free:
Children, including all Churchie students, are to be in the supervised care of an adult whilst in the centre;
If you are the last to leave you are responsible to turn the lights off and lock up.

Physical Activity Readiness Questionnaire:

Regular physical exercise is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is safe for most people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages 15 and 69, the PAR – Q will tell you if you should check with your doctor before you start.
Common sense is your best guide when you answer these questions. Please read all the questions carefully and answer each one honestly:

Physical Activity Readiness Questionnaire

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

If you answered YES to one or more questions:

Talk with your doctor by phone or in person BEFORE you start becoming more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
You may be able to do any activity you want – as long as you start slowly and build up gradually. Or you may have to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

If you answered NO honestly to all questions:

You can be reasonably sure that you can:

Start becoming more physically active – begin slowly and build up gradually. This is the safest and easiest way to go;
Take part in a fitness appraisal – this is an excellent way to determine fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or
If you are or may be pregnant – talk to your doctor before you start becoming more active.
Please Note: If your health changes so that your answer YES to any of the above questions you must contact the person in charge.

Acknowledgement*

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.I have read and understood the Rules of the Centre outlined aboveI will comply with rules as set out in this agreement and will take responsibility for keeping myself safe during activities in the Sir John Pidgeon Sports Complex.I agree to report to centre staff any activities, equipment or situations that I deem to be unsafe.I acknowledge that I am suitably qualified and experienced to be able to manage my own training in the Strength and Conditioning centre.I understand this physical activity clearance is valid for a maximum of 12 months from the date of completion and becomes invalid if my condition changes so that I would answer YES to any of the questions.

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