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FIT CLUB PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q

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					FIT C L UB

P HYSIC AL AC TIVITY R EAD INESS Q UE STIO NNAIR E (P AR -Q )

*IM P O R TANT – P lea se p rint , f ill out a nd p ost /d eliver t o
P ersona l Best St ud io, Unit 1 Frogma rsh M ill Sout h
W ood chest er G L 5 5ET b ef ore your f irst d a y of Fit C lub *
Physical activity should not be hazardous for most people. The PAR-Q
has been designed to identify those individuals who should seek
medical attention prior to beginning a physical fitness program.

Please answer all questions accurately and honestly to allow us to fully
determine your individual needs.

Date ………………………………………………

Last Name ………………………………………. First Name ………………………..

Address …………………………………………………………………………………

…………………………………………………………………………………………..

Email1 ………………………………….

Home phone ……………………………… Mob phone……………………………….

DOB ………………………………… Height …………….. Weight ………………

Occupation ……………………………………………………………………………..

Bo d y M e a su re m e n t s

Waist ……………………….. Chest …………………… Hips ……………………….

BMI (if known, can be taken at Fit C lu b if requested) …………………………….

Blood pressure ………………………..

Resting heart rate ……………………..

How did you hear about us? ……………………………………………………………

What would you say is the biggest single reason why you decided to get help
with your fitness?

…………………………………………………………………………………………..
                                                              Yes     No

1. Do you have high cholesterol?                               ….     ….

2. Has your doctor ever said that you have heart trouble?      ….     ….

3. Has your doctor ever told you that you have a bone or joint
   problem (such as arthritis) that has been or may be
   exacerbated by physical activity?                           ….     ….

4.   Has your doctor ever told you that your blood pressure
     was too high?                                              ….    ….

5.   Are you over-65 year of age and not accustomed to
     vigorous exercise?                                         ….    ….

6.   Are there any reason, not mentioned thus far, that wouldn’t
     allow you to participate in a fitness programme?            ….   ….




Signature ……………………………………………………………………………..




FIT C L UB C L IENT AC KNO W L ED G EM ENT, ASSUM P TIO N O F R ISK
AND FUL L R E L EASE FR O M L IABIL ITY O F P ersona l Best Fit C lub ,
P ersona l Best St ud io L t d a nd C a rl Bent on…..

By coming t o Fit C lub you a cknow led ge t ha t :

You have been informed of the need for medical approval if you have
a prior injury before joining in the fitness, exercise and training
programme which has been designed for Fit Club.

You are voluntarily choosing to participate in a Physical Exercise
Programme – Fit Club

You agree that any information, instruction or advice obtained from
the Fit Club may NOT be used as a substitute for your doctor’s advice
or treatment.
You agree that any information, instruction or advice obtained from Fit
Club will be used at your own risk.

Client acknowledges these physical activities involve the inherent risk of
physical injuries or other damages, including, but not limited to, heart
attacks, muscle strains, pulls or tears, broken bones, shin splints, knee /
lower back / foot injuries and any other illness, soreness, or injury
however caused, occurring during or after client’s participation in the
physical activities.

Client further acknowledges that such risk include, but are not limited
to, injuries caused by the negligence of an instructor or other person,
defective or improperly used equipment, over-exertion of a client, slip
and fall by client, or an unknown health problem of client. User agrees
to assume all risk and responsibility involved with participation in the
physical activities.

Client affirms that they are in good physical condition and do not suffer
from any disability that would prevent or limit participation in the
physical activities.

Client acknowledges participation will be physically and mentally
challenging, and agrees that it is their responsibility to seek competent
medical or other professional advice, regarding any concerns or
questions involved with their ability to take part in fit club physical
activities.

By signing this agreement, client asserts that he / she are capable of
participating in the physical activities. Client agrees to assume all risk
and responsibility for not exceeding his / her physical limits.

Signature …………………………………………………………………………

FIT C L UB

TE R M S AND C O ND ITIO NS

I certify that the answers to the questions outlined on the PAR-Q form
are true and complete to the best of my knowledge. I acknowledge
that medical clearance is required if I have answered “Yes” to any of
the questions on the PAR-Q form.

I understand and agree that it is my responsibility to inform my Fit C lub
trainer of any conditions or changes in my health, now and on going,
which might affect my ability to exercise safely and with minimal risk or
injury.
I ha ve rea d a nd und erst a nd t his t erm …… (init ia l)

I understand that I am not obligated to perform nor participate in any
activity that I do not wish to do, and that it is my right to refuse such
participation at any time during my training sessions. I understand that
should I feel light-headed, faint, dizzy, nauseated, or experience pain
or discomfort, I am to stop the activity and inform my Fit C lub trainer.

I ha ve rea d a nd und erst a nd t his t erm ………. (init ia l)

I understand that all Fit C lub sessions are based on 50-60 minute
sessions and should I arrive late, there is no guarantee I will receive the
full session.
I ha ve rea d a nd und erst a nd t his t erm ………. (init ia l)

I understand that Fit C lub bills clients on a pre-pay basis. Payment
must be made before the course is started. Both cash and cheques
are accepted. Cheques should be made payable to Personal Best
Studio Ltd. Payment is possible on line, please ask for details. I
understand that all Fit C lub courses are non-transferable and non-
refundable. Refunds are only available if you inform Fit C lub that you
are unhappy with the training by the third session.

I ha ve rea d a nd und erst a nd t his t erm ………. (init ia l)


I understand that should my Fit C lub trainer become ill or is away on
holiday, another trainer will be assigned to me so that my fitness
progress does not suffer. I also understand that in the event that my Fit
C lub trainer is no longer employed by Personal Best Studio Ltd, a
suitable Fit C lub trainer will be re-assigned to oversee my programme
and workout sessions.

I ha ve rea d a nd und erst a nd t his t erm ………. (init ia l)

I have read these Terms and Conditions and I understand all of its
terms. I sign it voluntarily and with full knowledge of its significance.

Signed ……………………………………………………………………………..



G oa l Set t ing
Write down your desired fitness goal here and sign it:

My goal is
………………………………………………………………………………

…………………………………………………………………………………………..

…………………………………………………………………………………………..

Signed
…………………………………………………………………………………..

E ma il ma rket ing p ermission

Are you happy to receive marketing / newsletter emails from Personal
Best Studio Ltd.?

Please circle                   Yes                       No

Signed

…………………………………………………………………………………..

Ad d it iona l services f rom P ersona l Best St ud io

     •   Personal fitness training
     •   Small group training
     •   Initial Corrective Exercise screen with Chiropractor
           Specialising in bio-mechanical analysis.
     •   Sports Massage / Thai massage.
     •   Power Plate




For more information on the above contact Carl Benton

Tel: 01453 873811
Email: carl@personalbeststudio.co.uk

				
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