Fitness PARQ & Liability Waiver

First Name*

Last Name*

D.O.B.*

Date

Your Mobile No.*

(07123456789)

Email*

example@example.com

EMERGENCY CONTACT DETAILS*

First NameLast Name

EMERGENCY CONTACT MOBILE*

(07123456789)

P.A.R.Q.*

	YES	NO
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?
Do you feel pain in your chest when performing physical activity?
Have you experienced chest pain when NOT performing physical activity in the last month?
Do you lose your balance because of dizziness or have you lost consciousness recently?
Do you have any bone or joint problems such as arthritis, which could be aggravated through physical activity?
Is your doctor currently prescribing you medications for high blood pressure or a heart condition?
Has your doctor ever told you to NOT exercise?
Is there any reason why you should NOT participate in physical activity?

Any other info: (recent surgery, illness or pains)

If you answered YES to one or more questions, are older than age 40 and have been inactive or are concerned about your health, consult a physician before taking a fitness test or substantially increasing your physical activity. You should ask for a medical clearance along with information about specific exercise limitations you may have. In most cases, you will still be able to do any type of activity you want as long as you adhere to some guidelines.

When to delay the start of an exercise program:

If you are not feeling well because of a temporary illness, such as a cold or a fever, wait until you feel better to begin exercising. If you are or may be pregnant, talk with your doctor before you start becoming more active.

Liability Waiver

The purpose of an exercise programme is to help you to achieve health and fitness goals. Your programme will be based upon your present activity/exercise levels and the goals that you wish to achieve. You will experience some feelings of exertion during each activity session and will become hot and uncomfortable at times. Your breathing and heart rate will increase as a result of these activities as would be expected from physical exercise of this type. As your fitness improves, you will participate in more vigorous levels of activity, if this is part of your goal, but these should remain within your capabilities. All activities will be explained and demonstrated to you but please feel free to ask questions about anything you wish. Any exercise programme carries with it an element of risk. Your sessions are designed to minimise the risks whilst providing an effective exercise/activity programme.

Please inform your trainer if, for any reason (such as illness or injury which might be aggravated by exercise, or eating certain foods), you should not participate in an activity. During your sessions with your trainer present you will be closely supervised. During your sessions where your trainer is not present you will be responsible for your own safety. If, at any time, you feel undue pain or excessive discomfort stop the activity and inform your trainer of your symptoms. You are free to withdraw from any activity at any time you wish.

AGREE*

Yes

I have read, understood and completed the PAR-Q. All questions have been answered to the best of my knowledge. I agree to take part in the programme described to me by my trainer. The nature, purpose, risks and benefits have been explained to me and I understand what is required of me and that I may withdraw at any time.

Payment and Cancellation Policy

Payments must be made in advance and can be made either by cash or by cheque made payable to: 48 hour notice of cancellation is required otherwise full payment will be incurred.

Sort code 608371 Account number 83919020

Account name Matt Hobson

Date*

Date

Digital Signature*

First NameLast Name

Fitness PARQ & Liability Form