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North Shore Running and Outdoor Fitness

www.nsrunningfitness.com.au

WARNING

When engaging in running and fitness programs and fitness classes, accidents can happen which may result in me being injured or my death. I declare that I have voluntarily read and understood this Warning, Exclusion of Liability and Release and Indemnity and accept and assume the risk of injury from participating in running and fitness programs and fitness classes, including activities with or produced by North Shore Running and Outdoor Fitness, outdoors, one on one, online and group training sessions and participating in any other activity carried on by North Shore Running and Outdoor Fitness trainers.

 

EXCLUSION OF LIABILITY

Except to the extent that terms are implied into a contract for the sale of goods and services by the Trade Practices Act 1974 (Cth) or other legislation, and cannot by contract be excluded, I agree that in consideration of being allowed to participate in fitness activities with/by North Shore Running and Outdoor Fitness that North Shore Running and Outdoor Fitness and their trainers, are absolved from all liability however rising from any injury or damage however caused (whether fatal or otherwise) due to any act of negligence to the fullest extent permitted by law (other than gross negligence), breach of duty, default and/or omission on the part of North Shore Running and Outdoor Fitness and their trainers.

 

RELEASE AND INDEMNITY

In consideration of North Shore Running and Outdoor Fitness providing me with online and/or face-to-face running and fitness training, which entitles me to engage in fitness activities recommended by North Shore Running and Outdoor Fitness, their personal trainers and running coaches, I:

1. release and forever discharge North Shore Running and Outdoor Fitness from all actions, suits, proceedings, claims, demands, penalties, fines, costs, and expenses however arising that I may have or may have had but for this release arising from or in connection with my involvement in fitness activities of North Shore Running and Outdoor Fitness; and

2. indemnify North Shore Running and Outdoor Fitness to the extent permitted under the Trade Practices Act 1974 (Cth) or otherwise by law in respect of any actions, suits, proceedings, claims, demands, losses, damages, penalties, fines, costs and expenses, arising as a result of or in connection with my involvement in fitness activities of North Shore Running and Outdoor Fitness whether caused or contributed to, directly or indirectly, by any act of negligence to the fullest extent permitted by law (other than gross negligence), breach of duty, default and/or omission on the part of North Shore Running and Outdoor Fitness.

 

FITNESS TO PARTICIPATE

I Agree
I declare that I am medically fit and free from impairment and able to participate in the fitness activities. I have undertaken or will undertake all necessary medical and/or fitness assessments and examinations.

 

I Agree
I declare that I have disclosed the details of any medical condition I have (in writing, over page), and of all recent medical treatment received by me.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and program/event updates by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Pre-Exercise Screening
1. Has your doctor ever told you that you have a heart condition or have you ever suffered a stroke?*
No
Yes
2. Do you experience unexplained pains in your chest at rest or during physical activity?*
No
Yes
3. Do you ever feel faint or have spells of dizziness during physical activity/exercise that causes you to lose balance?*
No
Yes
4. Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
No
Yes
5. If you have diabetes (type I or type II) have you had trouble controlling your blood glucose in the last 3 months?*
No
Yes
I have not been diagnosed with diabetes
6. Do you have any diagnosed muscle, bone or joint problem that you have been told could be made worse by participating in physical activity/exercise?*
No
Yes
7. Do you have any other medical condition(s) or injuries that may make it dangerous for you to participate in physical activity/exercise?*
No
Yes
8. Are you currently pregnant?*
No
Yes
9. Have you given birth before?*
No
Yes

If you answered 'YES' to any of the 7 questions above, you may need to seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity/ exercise. Please bring a doctors clearance letter to your next training session or email to claire@nsrunningfitness.com.au. 

If you answered 'NO' to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise. 


Date *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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