First Name *

Last Name *

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Date of birth *

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Job Title

Fitness Goals

Injuries/Obstacles

Emergency Contact (full name) *

Emergency Contact Phone Number *

What brings you here?

EMS Trial

Boogie Bounce

Personal Training

Challenge

Physical Activity Readiness Questionnaire (Par-Q)

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. Please check the box if the items apply to you. If the item does not apply leave empty

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

In the past month, have you had chest pain when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Do you feel pain in your chest when you do physical activity?

Do you know of any other reason why you should not do physical activity?

None of the above

IF YOU ACKNOWLEDGED HAVING ANY OF THESE HEALTH CONDITIONS

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.

If your health changes so that you then answer YES to any of the above questions, you must tell us. Ask whether you should change your physical activity plan.

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.

By ticking this box I indicate that I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction

Waiver of Liability

I hereby understand and acknowledge that the training, programs, and events held by FitTech Studios may expose me to inherent risks, including accidents, injury, illness or even death. I assume ALL risk of injuries associated with participation including, but not limited to, the equipment, falls, contact with other participants, and all other such risks being known and appreciated by me.

I hereby acknowledge my responsibility in communicating any physical and psychological concerns that might conflict with the participation in physical activity. I acknowledge that I am physically fit and mentally capable of performing the physical activities I choose to participate in.

After having read this waiver and knowing these facts, and in consideration of acceptance of my participation and FitTech Studios providing services to me, I agree, for myself and anyone entitled to act on my behalf, to HOLD HARMLESS, WAIVE AND RELEASE FitTech Studios, its officers, agents, employees, organizers, representatives, and successors from any responsibilities, liabilities, demands, or claims of any kind arising out of my participation in the FitTech Studios training, programs, and/or events.

By ticking this box, I indicate that I have read and understood this Waiver of Liability. I am aware that this is a waiver and a release of liability and I voluntarily agree to its terms.

Terms and Conditions

By ticking this box, I indicate that I have read and understood the Terms and Conditions at the link above.

Signature *

Clear

Trainer Section:

Please allow for the trainer to review the form with you and review any injuries / obstacles that you have noted or any items that might have been noted in the PARQ section. Please note that the trainer might elect not to proceed with the training session if there is any items of significance or if they deem it is necessary to get doctors approval before doing a session.

(*If this is submitted online before session just leave this section empty and advise the trainer you have completed the form)

Trainer Notes

Trainer has cited ID

Yes, confirmed identity.

No, ID not present.