I. Fitness Testing
The purpose of the fitness-testing program is to evaluate cardiorespiratory fitness, body composition, flexibility and muscular strength and endurance. The cardiorespiratory fitness test invilves a submaximal test that may include a bench strp test, a cycle ergometer test, or a one-mile walk test. Body compositiin is analyzed by taking several skinfold measures to calculate percentage of body fat. Flexility is determined by the sit-and-reach test. Muscular strength may be dertmined by an upper-body bench press test or a lower-body leg extension test. Muscular endurance may be evaluated by the one-minute, bent-knee sit-up test or the enducance bench press test.
II. Exercise Participation
I desire to engagae voluntatily in the IMpact FITness exercise program provided in order to attempt to improove my physical fitness. I understand that the activites are designed to place a gradually increasing workload on the cardiorespiratory system and thereby attemt to improve its function. The reaction of the cardiorespiratory system to such activites cannot be predicted with complete accuracy. There is risk of certain changes that might occure during or following exercise. These changed might include abnormalities of blood pressure or heart rate.
I understand that the purpose of the exercise program is to develop and maintain cardiorespiratory fitness, body composition, flexibility, and muscular strength and endurance. A specific exercise plan will be given to me, based on my needs and interests and my doctors recommendations. All exercise programs include warm-up, exercise at target heart rate and cool down. The programs may involve walking, jogging, swimming, or cycling (outdoor and stationary); participation in exercise fitness, rhythmic aerobic exercise, or choreographed fitness classes; or calisthenics or strength training. All programs are designed to place a gradually increased workload on the body in order to improve overall fitness. The rate or progression is regulated by exercising to target heart rate and rate of preceived exertion.
I affirm that I am responsible for monitoring my own condition throughout the tests and/or exercise program, and should any unusual symptioms occure, I will cease my participation and inform my instructor of the symptoms.
In signing this consent form, I affirm that I have read this form in its entirety and that I understand the description of the tests and their components. I also affirm that my questions regarding the fitness-testing program have been answered to my satisfaction.
In the event that a medical clearance must be obtained prior to my participation in the fitness-testing program, I agree to consult my physician and optain written permission from my physician prior to the commencement of any fitness tests.
Also, in consideration for being allowed to participate in the fitness training and/or exercise program, I agree to assume the risk of such testing or exercise, and further agree to hold harmless the IMpact FITness LLC and its staff members conducting such testing and/or the exercise program from and and all claims, suits, losses, or related causes of action for damaged, including, but not limited to, such claims that may result from injury or death, accidental or otherwise, during, or arising in any way from the testing or exercise program.
If you are younger than age 15, older than 69, or are pregnant or are looking to become pregnant please contact firstname.lastname@example.org for an alternant Par - Q form to fill out.
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most
people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the
ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being
very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.
If you answered YES to one or more of these questions, PLEASE VIEW THE STATEMENT IN THIS FIELD & ANSWER THE FOLLOWING QUESTIONS
Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.
· You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.
Find out which community programs are safe and helpful for you.
If you answered no to these two questions above & initialed, please complete the next form on the following page.
If you answered NO to all questions, please view this statement
If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:
· start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.
take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.
DELAY BECOMING MUCH MORE ACTIVE:
· if you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or
if you are or may be pregnant – talk to your doctor before you start becoming more active.
PLEASE NOTE: If your health changes so that you then answer YES to
any of the above questions, tell your fitness or health professional.
Ask whether you should change your physical activity plan.
Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.
NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes.
"I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction."
Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and
becomes invalid if your condition changes so that you would answer YES to any of the nine questions.
If you marked any of these statements in this section, consult your physician or other appropriate health
care provider before engaging in exercise. You may need to use a facility with a medically qualified staff.
If you marked two or more of the statements in this section, you should consult your physician or other appropriate health care provider before engaging in exercise. You might benefit from using a facility with a professionally qualified exercise staff to guide your exercise Program.
You should be able to exercise safely without consulting your physician or other appropriate health care provider in a self-guided program or almost any facility that meets your exercise program needs.
Modified from American College of Sports Medicine and American Heart Association. ACSM/AHA Joint Position
Statement: Recommendations for cardiovascular screening, staffing, and emergency policies at health/fitness facilities. Medicine and Science in Sports and Exercise 1998:1018.
Personal & Family Health & Medical History:
Please indicate if you (1), any primary relatives (2), or both (3) who have any of the following conditions. (Choose all that apply)
How many meals do you eat out?
What is your caffeine intake like? (Coffee, Energy Drinks, Soda, Etc.)
What is your alcohol intake if any?
If you are not sure which body type category you fall into here is a link to a simple test that helps: What Is Your Body Type? Take Our Test! Once you have the results choose other & enter the body type. The proceed below to put in the percentage info from the test of the Body Tyoe break down.
I reccomend myfitnesspal for tracking your nutrition & Polar Beat app for tracking how many calories your burning during physical activity (Requires a heart rate monitor)
Homework: 3 Days worth of nutrition tracked. Please attach the individual days. If you do not have it as a document in electronic form, you may email it or attach screen shots of it.
If you have not done the 3 day food intake it is fine. This info will be gathered later.
If you choose YES a document with info will be sent in order to perform the assessments on your own with a link to the form to submit your results. You'll have a choice of exercise for use in your bench mark assessment that will help guage your progress over the course of your program.
In the mean time please procced to the next page to submit basic assement info.
Please attach a front, back & a front picture with a sign or news paper indicating the date. Use good lighting and comfortable but minimal clothing. If the camera can add a time stamp please use it.
Males: gym shorts (show legs if possible)
Females: sports bra and gym shorts [If this makes you uncomfortable to wear please wear a tank top & shorts]
((Competitors, wear what you would on stage or during the compeition))
NOTE: If unable to attach please look to following options:
Drop/Attach un your client drop box folder - either in your client account or a special google drive folder set up between you & your coach
e-mailed directly to your coach
See attached photo for example.
Pictures should be done in the morning after your fasted weigh in (Fasted Weight is taken upon waking).
Fasted Weight Should be ideally taken upon waking up before eating, drinking, or showering.
Click the Browse Buttons below to attach your photos.