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Waiver, Release, and Assumption of Risk Form

 

THIS IS A LEGAL DOCUMENT

PLEASE READ CAREFULLY

 

 

I have volunteered to participate in a fitness program provided to me by (“Invicta Performance”), which may include, but may not be limited to, resistance training and aerobic or cardiovascular exercise. In consideration of Invicta Performances agreement to instruct and train me, I do here now and forever release and discharge and hereby hold harmless Trainer and his respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting there from.

 

THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) EQUIPMENT BELONGING TO TRAINER OR TO MYSELF THAT MAY MALFUNCTION OR BREAK; (2) ANY SLIP, FALL, DROPPING OF EQUIPMENT; (3) AND/OR NEGLIGENT INSTRUCTION OR SUPERVISION.

 

I have been informed of, understand and am aware that any exercise program, whether or not requiring the use of exercise equipment, is a potentially hazardous activity. I also have been informed of, understand and am aware that any exercise and/or fitness activities involve a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death, and that I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I agree that it is my responsibility to check all machinery and equipment is safe before I intend to use it.  I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death.

 

I agree to accept financial responsibility for any injury that I may cause either to myself or to any other participant due to his/her negligence. Should the above-mentioned parties, or anyone acting on their behalf, be required to incur legal fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Invicta Performance, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Invicta Performance.

 

I hereby grant Invicta Performance permission to use my photograph/video image in any and all publications for CrossFit or Invicta Performance, including website entries and social media, without payment or any other consideration in perpetuity. I hereby authorise Invicta Performance to edit, alter, copy, exhibit, publish or distribute all photos, images and videos. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I hereby hold harmless and release and forever discharge Invicta Performance from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate which may have or may have by reason of this authorisation. 

 

I have been advised that an examination by a physician should be obtained by anyone prior to commencing a fitness and/or exercise program, or initiating a substantial change in the amount of regular physical activity performed. If I have chosen not to obtain a physician’s consent prior to beginning this fitness program with Invicta Performance, I hereby agree that I am doing so solely at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all fitness related activities and/or exercises in which I participate.

 

Invicta Performance strives to provide a positive and encouraging environment for our clients. Anyone that is disruptive or negatively influences this environment is subject to having their membership revoked. This is at the sole discretion of management.

 

 I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS FORM IN ITS ENTIRETY AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST TRAINER FOR YOUR NEGLIGENCE OR THAT OF YOUR EMPLOYEES, AGENTS, OR CONTRACTORS.

 

This form is an important legal document that explains the risks you are assuming by beginning an exercise program. It is critical that you have read and understand this document completely. If you do not understand any part of this document, it is your ultimate responsibility to ask for clarification prior to signing it.

 

I Agree

 

Informed Consent for Exercise Testing This form is an important legal document. It explains the risks you are assuming by beginning an exercise testing program. It is critical that you read and understand it completely. After you have done so, please print your name legibly and sign in the spaces provided at the bottom. I hereby voluntarily give consent to engage in a fitness test.

 

I understand that the fitness test will involve progressive stages of increasing effort and that at any time I may, at my sole discretion, terminate the test for any reason.

 

I understand that during some tests I may be encouraged to work at maximum effort and that at any time I may, at my sole discretion, terminate the test for any reason.

 

I understand there are certain changes which may occur during the fitness test. These changes could possibly include abnormal blood pressure, fainting, irregular or abnormal heart beat, and, in very rare instances, heart attack, stroke, and/or death.

 

I understand that every effort will be made to minimise problems by preliminary examination and questioning, and close observation during the entire testing process.

 

I understand that I am responsible for monitoring my own condition throughout the testing process, and should any unusual symptoms occur, I will immediately cease my participation and inform the test administrator of the symptoms. Unusual symptoms include, but are not limited to: chest discomfort, nausea, difficulty in breathing, dizziness, light headedness, and joint or muscle pain or injury.

 

Also, in consideration of being allowed to participate in the fitness tests, I agree to assume all risks of such fitness testing, and hereby release and hold harmless Invicta Performance, and their agents and employees, from any and all health claims, suits, losses, or causes of action for damages, for any injury or death, including claims for negligence, arising out of or related to my participation in the fitness testing process.

 

I have read the foregoing carefully and I understand its content. Any questions which may have occurred to me concerning this informed consent have been answered to my satisfaction.

 

I Agree

 

Terms & Conditions

 

1. In addition to this form, Client will be required to sign and return the following forms to Invicta Performance prior to receiving a Fitness Consultation, Training Program Design, or beginning any Personal Training program:

a. Waiver, Release, and Assumption of Risk Form

b. Waiver, Release, and Assumption of Risk (Home Workouts), if applicable

c. Physical Activity Readiness Questionnaire (PAR-Q)

d. Health History Questionnaire

 

2. If you have any of the following physical conditions, you may be required to have a Medical Clearance and Physician’s Consent Form:

a. Hypertension (>145/95 mm Hg)

b. Hyperlipidemia (cholesterol >220 mg/dl or a total cholesterol-to-HDL ratio of >5.0)

c. Diabetes

d. Family history of heart disease prior to age 60

e. Smoking

f. Abnormal resting EKG

g. Any other condition that Invicta Performance in its sole discretion may deem to present an unreasonable risk to your health, were you to participate in a fitness evaluation or program.

 

3. Unless other arrangements are made, Personal Training sessions, and Program Design explanations (these services herein individually and collectively referred to as “sessions”) last approximately 60 minutes. In order to provide the best service to all Clients, Invicta Performance cannot commit to extending any particular session beyond its previously scheduled time. In those cases where schedules do permit, Clients may request to extend sessions beyond 60 minutes at the current hourly session rate.

 

4. Rates for Invicta Performance services are subject to change. Services prepaid for by Client, which are unused at the time of any rate change, will be honoured at the price already paid. Invicta Performance reserves the right to change conditions of membership, hours of operation, services offered and all fees and charges, at any time, at its sole discretion.

 

5. Time slots are available on a “first-come, first-served” basis by appointment. Sessions, whether purchased a la carte or as part of a package, must be paid for when the appointment is booked. Client may schedule prepaid sessions in advance.

 

6. In order to provide the best possible service to all Clients, Invicta Performance asks that all Clients be ready to begin their session at the scheduled time. Time lost at the beginning of a session due to a Client’s tardiness cannot be made up at the end of the session as that could potentially impact the next scheduled Client. Unless prior arrangements have been made, a Client will be deemed a “no-show” when they are fifteen minutes late for an appointment. No refunds or credits will be given for “no-shows”.

 

7. Regarding cancellations:

a. All qualifying cancellations will result in a credit being given which can be applied to a future session or other product or service from Invicta Performance.

b. All cancellations must be made with a minimum of 4 hours advance notice in order to receive credit for the session. Due to an inability to fill the previously blocked time period, cancellations with less than 4 hours notice given are classed as a "late cancellation" and will not qualify for a credit and Client will be charged for the session. TeamUp works on a three-strike policy. If three late cancellations are made in a two-week period, the Client’s membership will be automatically put on hold. The Client will have to contact Invicta Performance to rectify this. Cancellations must be made by using the TeamUp app/website to be deemed effective. 

c. If Client receives credit for a missed session, the credit must be used within 60 days of the missed session, or it will be waived.

d. If Invicta Performance needs to cancel a scheduled session, Client will receive credit for such session.

 

8. Payment is due at the time the appointment for a session is booked. Invicta Performance accepts cash, Visa, MasterCard, bank transfer and standing order. Should any payments, fees or other debts remain due but unpaid from any source, Invicta Performance may suspend the Member's use of the Membership services untill all fees and other debts are paid in full. If payment is not received the Membership may be cancelled. Invicta Performance may engage the services of a Debt Collection agency to manage member accounts with an outstanding debt. 

 

9. Clients are required to observe any and all rules of the gym or facility where workouts take place, if applicable.

 

10. Shirts and shoes are required at all times during sessions. Client should also have water available as necessary during the workout.

 

11. Clients have the right to terminate a particular exercise or workout at any time. You are in control of your workouts! If an exercise is uncomfortable or painful, or if you want to stop for any reason, you may do so. If a particular exercise is painful for you to do or you have an injury or other limitation that makes it difficult for you to do, Invicta Performance can attempt to substitute another exercise to work that particular muscle group.

 

12. You will get from your workouts what you put in. Results will vary by individual and Invicta Performance cannot guarantee specific results. Client acknowledges that Client is responsible for their decisions regarding whether or not to exercise consistently, eat properly, rest enough, and live a healthy lifestyle.

 

13. Invicta Performance respects your privacy. Due to the nature of our services, it is necessary to collect certain personal information from Clients. All information collected is treated as STRICTLY CONFIDENTIAL, and Invicta Performance will not share or redistribute your information with any third party except as necessary to provide services purchased by the Client, or as required by law. Any information gathered from a Client is simply for our records and, if applicable, necessary to provide the services to the Client for which we have been contracted.

 

14. All Terms and Conditions are subject to change. The most current version of these Terms, Conditions, and Policies will be supplied on request.

Participant’s signature / Parent or legal guardian (if participant is under age eighteen)

First Client's Name

First Name*

Last Name*
First Client's Date of Birth*
I certify that I am 18 years of age or older
First Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

First Client's Signature*
Second Client's Name

First Name*

Last Name*
Second Client's Date of Birth*
Second Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Third Client's Name

First Name*

Last Name*
Third Client's Date of Birth*
Third Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Fourth Client's Name

First Name*

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Fifth Client's Name

First Name*

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Sixth Client's Name

First Name*

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Seventh Client's Name

First Name*

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Eighth Client's Name

First Name*

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Ninth Client's Name

First Name*

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Tenth Client's Name

First Name*

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

Client'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 discounts 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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Physical Activity Readiness Questionnaire (PAR-Q)

A Questionnaire for People Aged 15 to 69

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active everyday. 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 you best guide when you answer these questions.  Please read the question carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered yes to one or more 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 you doctor about the kinds of activities you wish to participate in and follow his/her advice.

No to all questions

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 you basic fitness so that you can plan the best way for you to live actively.

Delay becoming much more active:

If you are not feeling well because of a temporary illness such as 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 you physical activity plan.

Informed Use of the PAR-Q.

(Company) assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity.   I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

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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