UC PARQ

epic fitness (universal components) gym informed consent and liability waiver

informed consent & liability waiver

While this form will help screen for potential health issues, we always recommend consulting your doctor before starting a new physical activity regime. Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming 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 your best guide when you answer these questions. Please read the questions carefully and answer each one honestly:

* Indicates required field

Name *

First

Last

Tel *

Email *

Adress *

Emergency Contact Name *

Emergency contact Tel: *

Description of Potential Risks:
I understand that the reaction of the heart, lung, blood vessels as well as other systems to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during the following exercise, which include abnormalities of blood pressure or heart attacks as well as other side effects. Use of weight lifting equipment, and engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures are not consistently followed. I understand that Universal Components or Faster Fitness Solutions shall not be liable for any damages arising from personal injuries sustained by you, the gym user while using the facility. I the Client/gym user assumes full responsibilities for any injuries or damages which may occur during and/or after training.

I hereby fully and forever release and discharge Universal Components and Faster Fitness Solutions from all claims, demands, damages, rights of action, present and future therein. I understand and warrant, release and agree that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, or comfort, or physical condition if I engage or participate (other than those items fully discussed on the health history form).

I state that I have had a recent physical check up and have my personal physician’s permission to engage in aerobic and/or anaerobic conditioning.
Description of Potential Benefits:I understand that a program of regular exercise for the heart, lungs, muscles and joints has many benefits associated with it. These may include a decrease in body fat, improvement in blood fats and blood pressure, improvement in physiological function and decrease in heart disease. I have read the foregoing information and understand it. Any questions, which may have occurred, have been answered to my satisfaction.

After signing by either party the form will no longer be editable.

I accept *

Your Signature *

pre-exercise readiness questionnaire

Has your doctor ever told you 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

Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity? *

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 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 your doctor about the kinds of activities you wish to participate in and follow his/her advice.
Find out which community programs are safe and helpful for you

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 your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144 / 94, talk with your doctor before you start becoming much more physically active.

Please print your name and confirm by clicking "accept" that you confirm that the information given is 100% accurate and you will let your trainer/gym supervisor know immediately if anything changes. *

I can confirm that the information given in this form is 100% accurate to the best of my knowledge *

i accept

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informed consent & par-q

epic fitness (universal components) gym informed consent and liability waiver

informed consent & liability waiver

pre-exercise readiness questionnaire

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