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Physical Activity Readiness Questionnaire (PAR-Q)

 

This PAR-Q aims to identify any reasons why you shouldn't physically exercise. This PAR-Q will also highlight any medical conditions or physical inabilities that you may need to speak to your GP about, and any considerations to take into account during your training. 

First Member's Name

First Name*

Last Name*

Phone*
First Member's Date of Birth*
First Member's Signature*
Second Member's Name

First Name*

Last Name*

Phone*
Second Member's Date of Birth*
Third Member's Name

First Name*

Last Name*

Phone*
Third Member's Date of Birth*
Fourth Member's Name

First Name*

Last Name*

Phone*
Fourth Member's Date of Birth*
Fifth Member's Name

First Name*

Last Name*

Phone*
Fifth Member's Date of Birth*
Sixth Member's Name

First Name*

Last Name*

Phone*
Sixth Member's Date of Birth*
Seventh Member's Name

First Name*

Last Name*

Phone*
Seventh Member's Date of Birth*
Eighth Member's Name

First Name*

Last Name*

Phone*
Eighth Member's Date of Birth*
Ninth Member's Name

First Name*

Last Name*

Phone*
Ninth Member's Date of Birth*
Tenth Member's Name

First Name*

Last Name*

Phone*
Tenth Member's Date of Birth*
Member'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*
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Please read the questions carefully and answer each one honestly.
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you had any 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 your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity? Recent surgery etc..*
No
Yes

If YES to any of the above questions please explain:
Covid-19 terms and conditions

The following terms and conditions are to be adhered to at all times by all site users during the Covid-19 epidemic. If these terms and conditions are not followed, Testlands Hub has the right to cancel your membership.

- All site users must sign in and sign out when entering and leaving the facility. This will be used for track and trace if needed. 

- Site users will only be allowed access to the building at the time their booking starts. Please DO NOT arrive early or you will be asked to wait outside.

- All customers must wash their hands with the provided washing facilities in reception before entering the facility. Customers are also advised to bring their own hand sanitiser.

- All site users must take the supplied spray bottle and cloth upon arrival. All equipment must be wiped down before and after use. Spray and cloth must be returned after session.

- All site users must queue using the designated floor markings. At no time must anyone walk ahead of people in the queue.

- Pre paid bookings or card only.

- There will be a limited number of exercise equipment to support social distancing and cleaning.

- One person per exercise zone.

- Maximum of 10 minutes in each exercise zone.

- Changing facilities will remain closed. 

- All customers must enter through the main entrance doors and exit through the exit door.

- All users must follow the one way system to avoid crossing paths with other users.


Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 16 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 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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