Gym Health Questionnaire Form

Gym Health Questionnaire Form
Full name

First NameLast Name
Birth Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
example@example.com
Phone Number
Emergency contact

First NameLast Name
Phone number
Clients Information - 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 said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel fain 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 worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction
Initials

Powered by Jotform SignClear
Client Information - Liability waiver
Acknowledgment of Risks

I, the undersigned, understand that participation in the Group Runners’ Strength Training Class (hereafter referred to as "the Program") involves physical exercise and fitness training, which includes but is not limited to, weightlifting, resistance exercises, bodyweight exercises, and cardiovascular conditioning. I acknowledge that such activities carry inherent risks, including but not limited to:

Physical injuries (e.g., strains, sprains, fractures, or other musculoskeletal injuries).
Potential pre-existing health conditions aggravated by physical activity.
Risks associated with the use of fitness equipment.
Other unforeseen risks that may result in personal injury, illness, or even death.

Medical Clearance

I affirm that I am physically fit and have no medical conditions that would prevent me from participating safely in the Program. I have consulted with a qualified healthcare provider, or I acknowledge that I am participating voluntarily and accept full responsibility for my health and well-being during this Program.

Assumption of Responsibility

I voluntarily assume all risks associated with participation in the Program. I understand and accept that it is my responsibility to:

Follow all instructions provided by the instructor(s).
Use the equipment only as directed.
Monitor my own physical condition during the class and cease activity if I feel discomfort, pain, or any other symptoms indicating possible harm.

Waiver and Release

In consideration of being allowed to participate in the Program, I hereby release and discharge Up and Running Performance, its officers, agents, employees, contractors, and affiliates (collectively referred to as "the Released Parties") from any and all claims, demands, damages, rights, or causes of action arising out of or related to my participation in the Program, including but not limited to claims of negligence by the Released Parties.

Indemnification

I agree to indemnify and hold harmless the Released Parties from any and all claims, liabilities, damages, and expenses (including attorneys' fees) arising from or related to my participation in the Program or my breach of this Waiver and Release of Liability.
Initials

Powered by Jotform SignClear
Photography/Video Release
I consent to the use of photographs or video recordings taken during the Program for promotional or educational purposes. I understand that these images may appear on social media, websites, or other promotional materials.
Initials

Powered by Jotform SignClear

Gym Health Questionnaire Form

Clients Information - Health questionnaire (Par-Q)

Client Information - Liability waiver

Photography/Video Release

Client Information - Billing policy