Name *

First Name

Last Name

What type of class would you like to book? *

In person / individual

In person / group training

Online / individual

Online / group training

Contact number *

(###)

###

####

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

Yes

No

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

Yes

No

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

Yes

No

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

Yes

No

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

Yes

No

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

Yes

No

If you have answered YES to any of the PAR-Q sections then you are required to gain consent from your doctor before participating in the exercise programme. An exercise programme will include exercises designed around your needs and goals. The programme will work all components of physical fitness and use the principles of training. You are advised to postpone entry into the programme if you feel unwell or have a temporary illness. You must inform your instructor of any changes to your health status whilst engaged in your training programme. *

I need consent from my doctor

I answered 'No' to all questions