BLUE CAT FITNESS PAR-Q

Welcome to Blue Cat Fitness!

Client Information.
Full name*

First NameLast Name
Date of birth

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Phone number
E-mail*
example@example.com
Emergency contact

First NameLast Name
Emergency contact's Phone Number

phone number
Client information - Health questionnaire (Par-Q)
Please read the questions carefully and answer each one honestly: YES or NO

Par-Q*

	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 balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worse by a change in your physical activity?
Is you doctor currently prescribing medication (for example water pills) for your blood pressure or a heart condition?
Have you had any surgery that the instructor should be awear of in the last 5 years?
Are you currently recieving treatment from a physiotherapist, osteopath etc?
Do you know of any other reason why you should not do physical activity?
Are you taking any medication? If yes please specify below.

If you answered YES to any of the above, please give details. If you have answered NO please write N/A*
If you have anwered NO to all of the questions above please make sure you work at your own pace, level and ability and build up gradually from your current ability level.

*If you have answered YES to any of the above questions you must consult with your doctor / medical professionals BEFORE starting your exercise programme to make sure it is safe for you to participate.

If you have any doubts about starting physical activity please consult with your doctor.

I have read, understood and completed this questionnaire to the best of my knowledge.
Signature*

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* Having answered YES to one of the above questions, I have sort medical advice and my GP / medical professional has agreed that I may take part in physical activity / exercise sessions.
Signature

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Online training.

Please ensure you have checked your workout space is safe and clear of any potential hazards ( rugs, furniture, pets etc).

Please make sure you have a non-slip floor and wear the correct footwear.

If equipment is used please ensure you have checked it for any faults before use.

Have your phone and drink handy, and try to position your screen so the instructor can see you.

I have read, understood and will follow the above statements;

(please sign below)
Signature*

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Client information - Liability waiver

I confirm that I am voluntarily engaging in physical activity and I understand that my participation involves risk of injury, and that I participate at my own risk. I understand I can stop my workout at anytime. I will inform the instructor of any personal or medical changes. I understand that Blue Cat Fitness / Lesley-Anne Nadin assume no liability for persons who undertake physical activity.
Please sign below if you have read and understood the above statement.
Signature*

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Date

DayMonthYear
Date
Thank you!
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Welcome to Blue Cat Fitness!

Client information - Health questionnaire (Par-Q)

Client information - Liability waiver