Fit Body Physical Activity Readiness Questionnaire (PAR-Q)

Do you have a heart condition or cardiovascular disorder?

YesNo

Is there any chest pain when your doing any physical activity?

YesNo

In the past month, did you experience any pain in the chest area when you're not doing anything?

YesNo

Do you usually lose your balance due to being dizzy or even lose your consciousness?

YesNo

Are you experiencing bone or joint problems that worsens if you change your physical activity?

YesNo

Are you currently taking medications for your blood pressure or heart condition?

YesNo

Is there any reason why you should not do strenuous physical activity?

YesNo

Have you attended a bootcamp or had a personal trainer before?

YesNo

Name

First NameLast Name

Gender

MaleFemale

Age

Date of Birth

Date

Phone Number

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation

Emergency Contact Person

First NameLast Name

Emergency Contact Person No.

Please enter a valid phone number.

Height

Weight

What are your fitness goals?

In consideration of permission to use, today and on all future dates, the property, facilities and services of Fit Body Milton keynes and to participate in weight training, cardiovascular training and other physical activities, client, on behalf of himself or herself, his or her heirs, personal representatives, and assigns, does hereby release, waive and discharge, Fit Body Milton Keynes/Major Fitness Solutions Ltd employees, volunteers, independant contractors, officers and agents (collectively, the "released parties") from liability from any and all claims arising from clients own negligence, the negligence of others, or the released parties' negligence originatingfrom clients participation of this programme. This agreement applies to: 1) personal injury (including death) from accidents or illnesses arising from the participationin pysical activities including, but not limited to, organised activities, classes, observation and individual use of facilities, premises, or equipment; and 2)any and all claimsresulting from the damage to, loss of, or theft of property. Client certifies that he or she knows of no medical problem (except those noted herein) that would increase his or her risk of illness and injuryas a result of participating in a physical training programme. Client understands that he or she has been to consult a physician prior to commencement of a physiacal training programme to ensure his or her state of wellness to participate in such strenuous activities. Client agrees to indemnify and hold the released parties harmless for any loss caused by client for which the released parties are held liable including legal fees and arbtration costs.

Please note, we occasionally take photos during sessions to use in marketing and advertising of Fit Body Milton Keynes products. By submitting this form you consent to let us use your image.

Physical Activity Readiness Questionnaire (PAR-Q)

Personal Information