Client Registration and PAR-Q Please click here to read GT Fitness and Wellbeing Terms and Conditions. Pre-Activity Readiness Questionnaire (PAR-Q) Name: * First Name Last Name Date of Birth * MM DD YYYY Email * Contact Number * (###) ### #### Name and Contact Number of Emergency Contact (###) ### #### Service * Personal Training Does you have (or have they ever experienced) any of the following? * Please tick all options that apply. High or low blood pressure Elevated blood cholesterol Diabetes Chest pains brought on my physical exertionn Childhood epilepsy Dizziness or fainting A bone, joint or muscular problems with arthritis Asthma or respiratory problems Any sustained injuries or illness Any allergies None If you have selected any of the options above, please give details. Has a doctor ever advised you against exercising or is there any other reason why you should not participate in physical activity? * Yes No If yes, please give details. I consent to my photo being taken and used for advertising purposes. * Yes No In agreeing to this form, * I understand that I am responsible for monitoring myself throughout any activity, should any unusual symptoms occur, I will ease participation and inform the coach/trainer. In the event that medical clearance must be obtained before I participate in an exercise session, I agree to contact the GP and obtain written permission prior to the commencement of the exercise activity, and that the permission be given to the instructor. I understand that if I fail to behave in a manner that is polite and social, I could be suspended from this particular activity. I affirm that I have read this form in its entirety, and I have answered the questions accurately and to the best of my knowledge. Informed Consent * The purpose of an exercise programme is to help you to achieve your 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 may 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 you are 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 the 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 the trainer present you will be closely supervised. During your sessions where the trainer is not present, you will be responsible for your own safety. If, at any time, you feel undue pain or excessive discomfort you should stop the activity and inform the trainer of your symptoms. You are free to withdraw from any activity at any time you wish. I understand the nature, purpose, risks and benefits of exercise and what is required of me and know that I may withdraw at anytime. Waiver and Release of Liability * This waiver and release of liability includes, without limitations, all injuries which may occur as a result of: a) Use of all amenities and equipment during participation in any personal training session, supervised or unsupervised b) The sudden and unforeseen malfunctioning of any equipment c) Our instruction, training, supervision, or dietary recommendations, and d) Slipping and/or falling during a supervised or unsupervised session. You acknowledge that you have carefully read this “waiver and release” and fully understand that it is release of liability. You expressly agree to release and discharge the trainer from any and all claims or courses of action and you agree to waive any right that you may otherwise have to bring a legal action against the personal trainer for personal injury and property damage. If any portion of this release from liability shall be deemed invalid according to current legislation at the time that cause for a claim may arise, then the offending provision(s) shall be severed and the remainder of this release from liability shall remain in full force and effect here from. I confirm that I have read and understood the terms of the waiver. I have read and accept the Terms and Conditions * This can be found at the top and bottom of the page. I accept the Terms and Conditions. Thank you for completing the PAR-Q and client registration.
