Program Information

Instructor: Ruby Bedair – YMCA Certified Personal Trainer
5147970412- rubybedair@gmail.com

Facility Location: Manara Centre – 6205 Grande Allée, Brossard, QC

Program: Modest Method Small Group Training

Before participating in any fitness classes, all participants must complete this form.

This form includes a health questionnaire, safety information, and a participation agreement to help ensure that classes are conducted in a safe and responsible environment.

Please read each section carefully and answer all questions honestly. This process helps the instructor understand your health status and ensure that participation is appropriate.

If you have any questions about the activities or the information requested, please ask the instructor before signing

 

I understand that physical exercise carries inherent risks of injury.

I acknowledge that I should consult my physician before starting any exercise program if I have medical concerns such as heart conditions, high blood pressure, diabetes, joint or bone problems, pregnancy or postpartum recovery, recent injury or surgery, or any other medical condition that may affect my ability to exercise safely.

If I experience dizziness, pain, discomfort, or unusual symptoms during exercise, I must stop immediately and inform the instructor.

I understand that the instructor may decline or restrict my participation based on the information provided in this health screening.

Registration does not guarantee participation. The instructor reserves the right to decline participation based on health screening responses.

I agree to inform the instructor immediately of any change in my health condition, injury, pregnancy, or medical treatment that occurs after completing this form and before or during participation in the program.

I understand that this health declaration must be updated if my health status changes or when requested by the instructor.

 

If you are pregnant, postpartum under 6 months, or have uncontrolled medical conditions, you should NOT complete registration or payment.

Participation in the program is not permitted during pregnancy or within 6 months postpartum.

 

I understand that participation in physical activity involves inherent risks including, but not limited to, muscle strains, sprains, joint injuries, falls, and other physical injuries.

I voluntarily choose to participate in the program and assume all risks associated with my participation.

To the extent permitted by Quebec law, I release the instructor, Ruby Bedair, and the facility Manara Centre, including its owners, staff, and representatives, from any claims, demands, or liability for injuries resulting from:

• Failure to follow instructions
• Undisclosed medical conditions
• Participant negligence

I understand that I am responsible for monitoring my own physical condition and for modifying or stopping exercises if I experience pain, discomfort, dizziness, or unusual symptoms.

I understand that the instructor may provide verbal instruction and, when necessary and with my consent, appropriate physical cueing to assist with posture and safe exercise execution.

I understand that the instructor is not a medical professional and that the instruction provided is for general fitness purposes only.

I understand that the instructor reserves the right to refuse or discontinue participation for any individual whose health condition, behavior, or participation may present a safety concern for themselves or others.If participation is discontinued by the instructor for safety reasons, the instructor may determine an appropriate resolution at their discretion.

I understand that choosing to stop participation in the program for personal reasons does not entitle me to any refund of program fees.

I understand that the instructor and facility are not responsible for the loss, theft, or damage of personal belongings.

I confirm that I have read and understood this document in its entirety. I understand that it contains important information regarding my participation and I agree to its terms voluntarily.