Helfit health questionnaire and liability waver.

Helfit health questionnaire and liability waiver
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Date of Birth
If you are under 18, parent or guardian's full name:
Address

Street Address

Street Address Line 2

Town / CityCounty

Postcode
Emergency contact Name:
Emergency contact Number:
Emergency contact relationship to you:
GP name and surgery:
What will you be coming to Helfit for? (tick all that apply)
Health questionnaire.
Have you ever been told by your doctor you have any medical condition that would make exercise unsafe for you or mean you should only exercise under medical guidance?
Do you feel pain in your chest when you do physical activity?
Do you feel pain in your chest when you are NOT doing physical activity?
In the past month, have you had any episodes of losing your balance because of dizziness, or have you lost consciousness?
Do you have a bone, joint, or spinal problem that could be made worse by a change in your physical activity?
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 have high blood pressure, high cholesterol, or diabetes?
Do you ever experience unexplained shortness of breath, palpitations, or unusual fatigue with everyday activities or light exercise?
Are you currently taking any prescribed medications for a heart condition, blood pressure, breathing, pain, or mood?
Are you pregnant, recently postnatal, or have you given birth in the last 6 months?
Do you have any ongoing or recent injuries (for example to your back, knees, shoulders, hips, or neck?
Do you have any other medical conditions, past surgeries, or anything else that might affect your ability to exercise safely?
If you answered YES to any of the questions above, please give details (including diagnoses, dates, medications, and anything else you think I should know).
If you answered Yes to any of the health questions, I may ask you to check with your GP before we start training, just to make sure your sessions are safe for you. Please also let me know straight away if anything about your health changes.
Meet Elton

Our front of house manager
Elton, my miniature dachshund, comes to work with me at the studio. He is very friendly and loves saying hello, but I know dogs aren't for everyone. If you have an allergy or would rather he wasn't around during your session, just let me know below and I'll make sure he is settled away from the studio.
Do you have a dog allergy, or would you prefer Elton not to be in the studio during your sessions?
Helfit Personal Training

To be completed by PT and group PT clients only.
I understand that PT and Group PT session cancelled with less than 48 hours notice will be charged in full.
I understand that if I want to end my PT or group PT sessions, I agree to give a minimum of 30 days notice.
I understand that any PT or group PT sessions I need to reschedule must be taken within 4 weeks of the original date, otherwise they will be forfeited
Helfit Classes

To be completed by everyone attending classes.
I understand that I can reschedule a class if I give at least 48 hours' notice. Classes cancelled with less than 48 hours' notice, or missed without notice (no-shows), will not be refunded.
I will tell Helen before each class about any new injury, pain or change in my health, and I understand some exercises may need to be adapted or skipped for me.
I understand that in a group class Helen cannot watch every person at all times, so I will work at my own level, rest when I need to, and ask if I am unsure about an exercise.
I will only use the reformers and gym equipment as shown, and only when Helen is present.
I will arrive on time, as the warm-up is an important part of exercising safely.
Informed Consent and Liability Waiver
I confirm that the information I have given in this form is accurate to the best of my knowledge. I understand that participation in exercise and physical activity carries an inherent risk of injury, and that I am responsible for listening to my body and working within my own limits. I understand that Helen Rose trading as Helfit will provide guidance and coaching based on the information I have given, but cannot be held liable for any injury, worsening of a pre‑existing condition, or other issues arising from information I have not disclosed, or from me choosing to ignore advice given. I agree to follow all safety instructions, use equipment as shown, and inform Helen of any changes to my health before continuing to exercise.

I agree to stop exercising and tell Helen straight away if I feel pain, dizziness, chest discomfort, shortness of breath or otherwise unwell during a session.

I understand that this waiver does not affect my statutory rights, and that nothing in it limits Helfit's responsibility for injury caused by its own negligence.

If the client is under 18, a parent or guardian must read this waiver and sign below on their behalf.
I have read, understood, and agree to the Informed Consent and Liability Waiver above.
Data protection and photos
Helen Rose trading as Helfit will keep the personal and health information in this form securely and use it only to plan safe exercise for you, and to contact you or your emergency contact if needed. Your health information is only used with your consent, which you give below. It will not be shared with anyone else without your permission, unless needed in an emergency or required by law.

Your information is kept while you train with Helfit and for up to 3 years afterwards, in case of an insurance or legal query, and is then securely deleted. You can ask to see, correct or delete your information, or withdraw your consent, at any time by contacting Helen. If you are unhappy with how your information is handled, you can contact the Information Commissioner's Office (ico.org.uk).
I consent to Helfit storing and using my personal and health information as described above.
Occasionally I share photos and videos from sessions on Helfit social media (@helfitpt). Are you happy to be included?
Signature (parent or guardian if under 18)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Helfit health questionnaire and liability waiver

Health questionnaire.

Meet Elton

Helfit Personal Training

Helfit Classes

Informed Consent and Liability Waiver

Data protection and photos