• Form

  • Date of birth*
     - -
  • Format: 00000 000000.
  • Are you taking any medication or supplements?*
  • Have you had any operations?*
  • Are you pregnant?*
  • Have you experienced any of the following past or present?

  • Please discuss with me before starting a session.

  • Has your doctor ever said 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 a 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 a bone or joint problem (for example back, knee or hip) that could be made worse by a change in your physical activity?*
  • Is your doctor currently prescribing medication for your blood pressure or heart condition?*

  • I understand that the purpose of the EmPower is to provide safe and effective exercise to improve health and fitness.

    The outdoor session may include:

    • Cardio.
    • Walking / stepping over a range of distances and varying terrains.
    • Resistance training exercises using bands and body weight to improve muscular strength and endurance.
    • A mixture of dynamic stretching for the warm up and static stretches for the cool down to improve movement around the joints and range of motion.

    Potential Risks

    The exercise session is designed to place a gradually increasing workload on the cardiovascular and muscular systems. The reaction of the body to such exercise cannot always be predicted with complete accuracy. There is a risk of certain changes that might occur during or following exercise.

    I understand that I am responsible for monitoring my own condition throughout the session and that should any unusual symptoms occur, I will cease my participation and inform you.

    Potential Benefits

    I understand that a programme of regular exercise has been shown to be beneficial.

    • Improves cardiovascular fitness
    • Burns fat
    • Lifts your mood
    • Improves your posture
    • Improves bone density

    The EmPower approach has been explained to me and my questions regarding the session have been answered to my satisfaction. I understand that I am free to withdraw at any time. The information obtained will be treated as privileged and confidential.

  • Date*
     - -
  • What results do you want to achieve?*
  • How would you rate your present level of fitness?*
  • How did you hear about EmPower? (Tick all that apply!)*

  • EmPower Safety Guidelines

    Welcome to your first EmPower session. I have put together the checklist to help you achieve a safe and enjoyable workout. Read carefully and feel free to ask any questions.

    • Wear TRAINERS and comfortable clothing that you don’t mind getting sweaty in.
    • You should wear a good support bra.
    • Choose appropriate clothing for the season: wearing layers is often best as we can get caught out.
    • We are out whatever the weather so you may need waterproofs, hats, gloves.
    • In summer you may need a hat and sunblock.
    • Bring a mat and WATER!

     

    BEFOREHAND

    • Try to run to the session to get the most out of it

    FITNESS IS FUN!

    I try to cater for all levels of fitness and different levels of exercise will be indicated. Even so, do your own personal check to see if you are really up to doing the session. Sleep deprivation is our biggest enemy and can cause injury so assess your energy levels and adjust your workout accordingly.

    I hope you enjoy the workout and that after a few sessions you will feel the benefit. Exercising can give you a natural high so if you are feeling down remember just getting out and getting the body moving is a great way to start feeling more positive.

     

    Terms and Conditions

    • Sessions that are cancelled with less than 24 hours notice will result in forfeit of the session.
    • Sessions changed with less than 48 hours notice must be rearranged for the same week. On-line options may be available.
    • Sessions will not be extended due to lateness of the client or interruptions caused by the client.
    • Cooling off period - refunds will be issued within 14 days of the first payment (unless a session has already taken place).
    • All information given is correct to the best of my knowledge.
  • Photography, I give consent for EmPower to use images taken during our sessions on their website, social media channels and digital communications materials, including advertising material and printed publications*
  • Should be Empty: