Group Fitness

Client Health Questionnaire
Full name*

First NameLast Name
Birth Date*

DayMonthYear
E-mail*
example@example.com
Phone Number*
Emergency contact*

First NameLast Name
Phone number*
Section 1

HEALTH
Health questionnaire (Par-Q)
Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

Par-Q*

	Yes	No
Has your doctor ever told that that you have a heart condition or have you ever suffered from a stroke?
Do you ever experience unexplained pains in your chest at rest or when you do physical activity?
Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?
Have you had an asthma attack requiring immediate medical attention at any time in the last 12 months?
If you are diabetes (type I or type II) have you had trouble controlling your blood glucose over the last 12 months?
Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity?
Do you have any other medical condition (s) that may make it dangerous for you to participate in physical activity/exercise?

Are You On Regular Medication

YesNo
Are you fully aware of the Potential Side Effects of Your Medication, as well as the Possible Impacts that Embarking on a New Exercise Regimen Might Have?
I have read, understood and completed this questionnaire. I understand that if I answered yes to any of the above. I am to seek guidance from my health professional prior to undertaking physical activity.
Initials*

Clear
About You
Which Class are You Joining? (Select all that apply)

PilatesStrong & FunctionalSeated AerobicsPersonal Training
What is Your Primary Reason for Joining Our Group Fitness Classes

Improve Overall HealthImprove StrengthImprove BalanceImprove MobilityImprove cardiorespiratory FitnessOther
How Would You Describe your Current Activity Level

Sedentary (little or no exercise)Light Active (light exercise/sports 1 - 3 days per week?Moderately Active (moderate exercise/sport 3 - 5 days per week)Very Active (hard exercise/sports 6 - 7 days per week)Super Active (very hard exercise/physical job & exercise twice per day)
On Average, How Many Days Per Week are You currently Exercising?
On Average, How Many Hours a week Do You Exercise?
Are you Looking at Increasing Your Weekly Activity?

YesNo
If yes, How Much Would You Like to Increase Your Physical Activity. e.g. 20%
What is Your Biggest Challenge that Could Prevent you from achieving Your Fitness Goals?
If You have Any Additional Questions or Comments, Please Let us Know
Terms & Conditions
Registration: All participants must book the class via the online booking page.

Payment: All zoom class fees must be paid in full prior to the start of the class. Participants joining the class in person pay on arrival.

Cancellations: Please text sharon on 0438 890089 to advise you are not attending. This allows us to give your spot to someone on the Wait List.

Class Schedule: The class schedule is subject to change. We reserve the right to cancel or reschedule classes as necessary. Registered Participants will be notified of any changes as soon as possible.

Participant Responsibility: Participants are responsible for ensuring they are in good health and physically capable of participating in the class. If you have any health concerns or medical conditions, please consult with a healthcare professional before joining the class.

Safety: Participants are responsible for ensuring they have a safe space to exercise and the appropriate equipment (if necessary) for each class. We are not responsible for any injuries or accidents that may occur during the class.

Privacy: We respect your privacy. Personal information collected during registration will only be used for the purpose of managing your participation in the class. We will not share your information with third parties without your consent.

Intellectual Property: All class content, including videos, routines, and other materials, are the property of Super Ageing and are protected by copyright laws. Participants may not record, reproduce, distribute, or use the class content in any way without our express written permission.

Disclaimers: Super Ageing is not responsible for any technical issues that may prevent participants from accessing the class, including but not limited to internet connection problems, software or hardware failures, or issues with the video streaming platform.

Code of Conduct: Participants are expected to behave respectfully and professionally during the class. We reserve the right to remove any participant who is disruptive or behaves inappropriately.

Changes to Terms and Conditions: We reserve the right to change these terms and conditions at any time. Any changes will be posted on our website and will take effect immediately.

Cost: Per Class $9. Cota Members $7 Membership number must be supplied.
Initials*

Clear
Client informations - Liability waiver
I am aware of the risks in observing or participating in the activities offered and sponsored by Super Ageing and I understand that all sports or fitness that I will execute and participate in are entirely at my own risk and perils. I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of these risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement. I realise that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I sustain, including personal injuries to me, damage to my property, or damage arising out of my death. It is understood that Super Ageing is responsible for any damage that would be resulting from a fault of Super Ageing and its representatives.
Initials*

Clear

Client Health Questionnaire

Section 1

Health questionnaire (Par-Q)

About You

Terms & Conditions

Client informations - Liability waiver

Client informations - Signature