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					Physical Activity Readiness Questionnaire

Name                                                            Weight
Male/Female                                                     Height
Occupation                                                      Blood Pressure
Address
Tel No
D.O.B
Emergency contact
GP name and telephone number


                                                                 YES     NO
   Has your doctor ever said that you have a heart condition
    and that you should only do physical activity
    recommended by a doctor?

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

   In the last month have you had chest pains when you
    were not doing physical activity?

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

   Have you fallen more than twice (no matter what the
    reason) in the last year?

   Do you have osteoporosis or arthritis or any other joint
    problems that could be made worse by a change in your
    physical activity?
   Is your doctor currently prescribing drugs for your blood
    pressure or heart condition?

Are you/ have you been pregnant within the last 12 months
Do you know of any other medical condition that may
prevent you from doing this program?
Do you know of any other reason why you should not be
physically active?
 Do you suffer from any of the following:
High or low blood pressure
Asthma/Emphysema
Epilepsy
Diabetes
Stroke


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Asthma
Arthritis
Impaired hearing
Impaired vision
Overweight
If you have answered yes to any of the question above you must seek
medical advice before participating on the programme.

   How active are you? (circle as appropriate)
10 up to 20 mins          low exercise            3-5 times a week
30 mins                   medium exercise         3-5 times a week
45 mins                   high exercise           3-4 times a week
60 mins                                           4+ times a week
Can you get up from the floor with                YES    NO
ease?
Can you walk for 5, 10, 15, 20, 30                YES    NO
minutes without feeling breathless?
(circle as appropriate)
How many flights of stairs could you
walk up without feeling tired?
                                                          YES        NO
 What are you aiming to achieve?
Reduce body fat/ tone up
Increase muscle mass/endurance
Pain relief
Increase flexibility/power
Getting up and down stairs
Getting out of the bath with ease
Improve posture
A healthier heart
Increase confidence
Reduce stress
Get fitter
Weight loss
Improve balance
Improve co-ordination




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Other, please explain




   What are your hobbies?




   Why do you want to participate on this program?




   What could prevent you from doing this program?




   What could you do to help you stay on the program once you have
    started?




   How will this program help you?




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                                                                          YES       NO
   Are you presently performing a fitness programme? If
    yes, please say what

   Do you currently take part in a sport or would like to start,
    if yes, what is the sport?

   If you answered yes to the previous question what are your goals?




   How many times a week would you be able to exercise?
   Have you ever smoked, if yes how many, per day
   Do you drink any alcohol, if yes how many glasses a
    week?
   Do you eat three regular meals a day?
   Do you snack between meals?
   How many portions      fruit     veg    meat     fish                 dairy     fibre
    of fruit, vegetables,
    meat, fish, dairy
    products and fibre do
    you eat?
   How much water do you drink a day?



Before signing at the end of the document, please read carefully the following

Terms and Conditions

1. INTERPRETATION
1.1 All references to Olives Bodycare in these Terms and Conditions shall mean Olives
Bodycare, its owners, personal trainers, authorised agents, employees and representatives.
2. ELIGIBILITY
2.1 Membership of Olives Bodycare is restricted to individuals aged 18 years and older. By
using this site, you represent and warrant that you meet this requirement.
2.2 By becoming a member you agree that all the information you provide is true and correct
to the best of your knowledge and that if any of the answers to the questions in the Initial
Consultation change during your membership the onus is on you to inform Olives Bodycare of
such changes in writing.
2.3 You agree that you will not allow any non-member to have access to any of the advice or
information or services of Olives Bodycare and you also agree that you will not allow any
other person to impersonate you in any communication with Olives Bodycare including but not
limited to email communication.
3. DURATION OF MEMBERSHIP
3.1 Your membership will be for one calendar year starting on the date of your payment.




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3.2 While all reasonable efforts will be made by Olives Bodycare to help you achieve your
objectives, Olives Bodycare will not be held responsible if you do not achieve your objectives
and this will not be grounds for a refund of your membership fee either in full or in part.
3.3 Your membership may be terminated by Olives Bodycare at the sole discretion of Olives
Bodycare if you breach any of the provisions of these Terms and Conditions.
4. EXERCISE SAFETY
4.1 Before you become a member you must read and understand and comply with the
following rules on exercise safety. By becoming a member you are deemed to have read and
understood these rules:

4.2. Do not embark on an exercise programme without first consulting your doctor and
obtaining medical clearance.
4.3. Before your exercise session, always warm up first. This means mobilising all the joints in
their natural range of motion in smooth slow motions for at least 3 minutes, then performing
gentle exercise for another 3 minutes to gradually raise the heart rate before starting your
main exercise session.
4.4. Do not exercise if you feel unwell. Get better first. If you have an injury, do not exercise
the injured body part.
4.5. During exercise, stop if you feel unwell or dizzy or light headed, or if you experience any
pain.
4.6. When using weights, ensure that the correct technique is not compromised by using
weights that are too heavy for you. All movements should be controlled, smooth and slow,
with your body in the correct position throughout. Do not perform an exercise if you are
unsure of the correct technique. If you are unsure about any exercise ring the help line for
guidance before embarking on the exercise.
4.7. Do not exercise for more than an hour at a time. There’s no point in exceeding an hour,
unless you are an experienced athlete and you are exceeding one hour for a valid reason.
4.8. Do not exercise the same muscle group two days in a row.
4.9. Do not exercise if you have eaten a meal in the last 90 minutes (45 minutes if you just
had a small snack). You need to digest the food first.
4.10. Do not exercise if you have not eaten anything in the last 3 hours. You will not have
enough energy to perform an effective exercise session.
4.11. Wear comfortable gym clothes, especially a good fitting pair of trainers with good treads.
Ensure your laces are well tied and are not dangling, so you don’t trip up. Also ensure your
clothing has no excessively baggy parts that could snag on exercise equipment. Beware of
jewellery that may interfere with a safe exercise session. Remove all loose bracelets or
necklaces, and put them in a safe place.
4.12. At the end of an exercise session, cool down for about 5 to 10 minutes by lowering the
heart rate gradually with progressively more gentle exercise, and finally always stretch all the
muscles you have exercised.
4.13 The rules in 4.1 above are not intended to be exhaustive and should not be construed as
such.


5. PAYMENT
5.1 Payment of the full amount of your annual/monthly membership £117.60 or £11.00 is
required before your membership is activated. All payment must be in pound sterling.
5.2 Payment is by Paypal or by cheque (see www.paypal.com/uk) Olives Bodycare accepts
no responsibility for any errors made by Paypal.
6. ASSESSMENT FORMS
6.1 You will not receive your first workout advice until you have completed and returned all
the online assessment forms emailed to you. This is for your own safety to ensure the advice
you receive takes into account all your medical history.



7. USE OF Olives Bodycare
7.1 The information, recommendations, advice and instructions contained in this website and
in any emails sent to you by Olives Bodycare, are for informational purposes only.




                                               5
7.2 You should not rely upon any information provided by Olives Bodycare as a basis either in
whole or in part for making any legal or medical or financial decisions.
7.3 You should not undertake any exercise programme or change your nutritional intake or
make any lifestyle change without first seeking the advice of your doctor and obtaining
medical clearance from your doctor. You should not rely on the information and advice of
Olives Bodycare as a substitute for the professional medical advice of your doctor.
7.4 You may not use this site for any unlawful purpose.
8. INTELLECTUAL PROPERTY
8.1 You acknowledge that all content and underlying code contained in the Olives Bodycare
website are owned by Olives Bodycare and that the contents of this website are the exclusive
copyright of Olives Bodycare.
9. WARRENTIES AND DISCLAIMERS
9.1 In receiving any oral or written information or advice or other communication from Olives
Bodycare, you assume the risks inherent in exercise, increased activity levels, physical
exertion, changes in lifestyle, changes in nutritional intake and, subject to your statutory
rights, Olives Bodycare shall not be liable for, and you agree to hold Olives Bodycare free
from any liability for, any claims, demands, damages, rights of action or causes of action
present or future including but not limited to lost profits, special damages, incidental damages
or consequential damages arising directly or indirectly from use of the Olives Bodycare
website, any email advice or any other information provided by Olives Bodycare. However,
Olives Bodycare does not seek to exclude or limit liability for death or personal injury caused
by the negligence of Olives Bodycare.
9.2 Olives Bodycare warrants that it will make all reasonable efforts to provide a professional
and timely service. Any complaints should be emailed to Olives Bodycare using the email
links provided in the website. In addition any urgent complaints should be brought to the
attention of the senior personal trainer Olive White by telephoning mobile 44 07961188727.
Furthermore your statutory rights are unaffected by these Terms and Conditions and these
Terms and Conditions do not in any way seek to limit the liability Olives Bodycare in the event
of death or personal injury resulting from the negligence of Olives Bodycare.
9.3 Olives Bodycare may provide links to information or recommend products or services
provided by other entities and in so doing makes no representations, guarantees or
warranties as to the products or services of any such entities.
9.4 Olives Bodycare does not guarantee or warrant that any materials or information or files
or emails sent to you by Olives Bodycare is free of viruses or other code containing
destructive properties. You are responsible for implementing reasonable measures to
safeguard against viruses and other code containing destructive properties.
9.5 Subject to your statutory rights, Olives Bodycare is not liable to you or any third party for
any act or omission by you or any third party taken in reliance upon any information or advice
provided by Olives Bodycare.
9.6 Olives Bodycare does not warrant the availability or accessibility of this site and you are
solely responsible for all Internet and telecommunications connections and choice of
hardware and browser.
10. AMENDMENT
10.1 Any amendment, change or modification of these Terms and Conditions shall be made
only by the express written direction of Olives Bodycare by updating these Terms and
Conditions as set out in this site. You shall be deemed to fully accept any such amendments.
Olives Bodycare warrants that any such amendments will be reasonable and that existing
clients will be given reasonable notice.
11. ENTIRE AGREEMENT
11.1 These Terms and Conditions as set forth on this site are the only terms and conditions of
this agreement. The provisions of these Terms and Conditions shall be severable and should
any portion of these Terms and Conditions be deemed unenforceable such unenforceability
shall not affect the enforceability of the rest of these Terms and Conditions.
11.2 These Terms and Conditions shall take precedence over any contrary or additional
undertakings or warranties or guarantees made by Olives Bodycare personal trainers,
authorised agents, employees or representatives whether made verbally or in writing.




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12 THE DECLARATION FORM

The Law Of England and ways shall govern this contract and by signing this contract you are
accepting this.




I accept the above terms and conditions


Print name _____________________________________


Clients Signature ________________________________



Date __________________________________________


Olives Bodycare Signature ________________________



Date __________________________________________



Declaration Form
This document is a release form.
By singing this document you acknowledge the following:

   You have read and accepted the terms and conditions
   You have completed the Physical Activity Readiness questionnaire
    honestly and accurately
   You are willing to partake in the exercise program at your own risk
   You have no physical restrictions, disabilities or injury you have not
    declared to us.
   You take full responsibility for any injury or damage to your person
   You will not seek to penalise, prosecute or claim compensation form
    Olives Bodycare in the event of injury or damage


Client Signature _________________________________________


Witness Signature _______________________________________




                                             7
Date __________________________________________________



On completion of the questionnaire and declaration form please print
out the whole document and send it to the following address :

PO BOX, Olives Bodycare, Po Box 44689, London, N16 0XW
You can contact us on 0207 923 0548 or email us at
olivesbodycare@btinternet.com




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Description: On line personal Training