NLF PAR-Q and Medical History Form

Today's Date*

MonthDayYear
Date
Are you completing this form on behalf of yourself (at least 18 years of age) or for a Minor?*

Myself. I am at least 18 years of age.A minor. I am the parent or legal guardian.
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Minor's Full Name*

First NameLast Name
Minor's Date of Birth*

MonthDayYear
Date
Your Name (parent or legal guardian)*

First NameLast Name
Your Relationship to Minor*
Email*
example@example.com
Phone Number*

Emergency Contact Info

This information will only be used in the event of an accident or medical emergency.
Emergency Contact Name*

First NameLast Name
Relationship to Participant *
Emergency Contact Phone Number*
Please enter a valid phone number.

I, First Name* Last Name* , agree that the information on this form is true and accurate to the best of my knowledge and that I have disclosed any conditions or medical history that may put me at risk. I understand that my personal trainer and/or No Limit Fitness staff are not able to provide me with medical advice with regard to any medical conditions I may have, and that this information is used only as a guideline to the limitations of my ability to exercise. I will release my personal trainer and/or No Limit Fitness staff from any liability for injuries or worsened health conditions that result from training. I take full responsibility for consulting my physician before engaging in physical activity if I answered 'YES' to one or more of the previous questions.
I, {yourName}, agree that the information on this form is true and accurate to the best of my knowledge and that I have disclosed any conditions or medical history that may put Minor's First Name Minor's Last Name at risk. I understand that my personal trainer and/or No Limit Fitness staff are not able to provide me or {minorsFull} with medical advice with regard to any medical conditions {minorsFull} may have, and that this information is used only as a guideline to the limitations of {minorsFull}'s ability to exercise. I will release No Limit Fitness staff from any liability for injuries or worsened health conditions that result from training. I take full responsibility for consulting our physician before {minorsFull} engages in physical activity if I answered 'YES' to one or more of the previous questions.
Signature*
Date Signed*

MonthDayYear
Date

LifeStyle

If you are completing for a minor, please answer questions on their behalf.
Do you smoke?*

YesNo
Do you drink alcohol?*

YesNo
Do you have experience in sports performance training?*

YesNo
Do you stretch often?*

YesNo
How many hours do you sleep at night? Hours of sleep*
What would you rate your stress level from 1 to 10 (1=very low, 10=very high)? Number 1 to 10*

Sports Information

If you are completing for a minor, please answer questions on their behalf.
Are you currently involved in a sport?*

YesNo
Which sport? *
What is your current position?*
Which most accurately describes your level of seriousness?*

Rec/FunCollegePro/Dream
Do you want to continue playing sports in college?*

YesNo
Have you ever worked with a Personal Trainer?*

YesNo

This contract will provide the necessary information to make an informed decision of whether or not to participate in a training program. Please do not hesitate to ask any questions.

Minor Acknowledgment. In the case of a minor Participant, the Undersigned parent or legal guardian acknowledges that he/she is not only signing this Agreement on his/her behalf, but that he/she is also signing on behalf of the minor and that the minor shall be bound by all the terms of this Agreement. Additionally, by signing this Agreement as the parent or legal guardian of a minor, the parent or legal guardian understands that he/she is also waiving rights on behalf of the minor that the minor otherwise may have. The Undersigned parent or legal guardian agrees that, but for the foregoing, the minor would not be permitted to participate in the Activity. By signing this Agreement without a parent or legal guardian’s signature, Participant, under penalty of fraud, represents that he/she is at least 18 years of age. If signing as the parent or guardian of a minor Participant, signing adults represent that they are a legal parent or guardian of the minor Participant.

REVIEW THE FOLLOWING STATEMENTS AND INITIAL TO VERIFY YOUR UNDERSTANDING.
Initials* I understand there are inherent risks in participating in a program of strenuous exercise. I accept full responsibility for consulting a physician about any health conditions of mine that may affect my ability to participate in the fitness program. If I choose not to see a physician for medical clearance prior to beginning a fitness program, I verify that I am doing so at my own risk and against recommendation of my personal trainer.
Initials* I certify that the answers to the questions outlined on all of my submitted personal training forms are true and complete to the best of my knowledge.
Initials* I understand that I am not obligated to perform any activity that I do not wish to do, and that it is my right to refuse participation at any time during my training sessions.
Initials* I understand that if I feel lightheaded, faint, dizzy, nauseated, pain, or discomfort, I am to inform my personal trainer and stop the exercise immediately.
Initials* I understand the results of any fitness program cannot be guaranteed and that my progress depends on my effort and cooperation in and outside of the sessions.
Initials* I understand if I arrive late to a scheduled training session that I will not receive the full time allotted. If my personal trainer is late for a session, I will still receive the full session time.
Initials* I understand that all personal training sessions are non-transferable and non-refundable.
Initials* I understand that my personal trainer operates on a scheduled appointment basis. I agree that if I do give notice of cancellation within 24 hours I will be charged in full for that session.
Initials* I understand that during a training session, my personal trainer may have to touch my muscles or joints to correct alignment or to focus my concentration on a particular muscle area to be targeted. If I feel uncomfortable or experience any type of discomfort with this form of touch, I will immediately request that it be discontinued.
Initials* I certify that the usage of any nutritional supplements is done under my own will and has not been prescribed by my personal trainer.
Initials* I understand that photos and video footage of me may be taken during training sessions and I provide No Limit Fitness employees the absolute right and permission to use this media for any lawful promotional, advertising, or marketing purposes. ACCEPT DECLINE*
I, First Name* Last Name* certify that I have read and initialed the statements above to verify my understanding and consent. I fully accept the responsibility to participate in a personal training program.
I, {yourName}, certify that I have read and initialed the statements above to verify my understanding and consent. I fully accept the responsibility for Minor's First Name* Minor's Last Name* to participate in a personal training program.
Signature*
Date Signed*

MonthDayYear
Date
Should be Empty:

	Yes	No
Has your doctor ever said that you have a heart condition that requires approval or supervision for physical activity?
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 worsened by a change in your physical activity?
Do you have a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?
Are you pregnant now or have given birth within the last 6 months?
Have you had a recent surgery?
Do you take medications, either prescription or non-prescription, that may affect your ability to participate in physical activity?

Emergency Contact Info

Physical Activity Readiness (PAR-Q)

Medical History

LifeStyle

Occupational

Sports Information

Fitness Goal Setting