Ignite fitness & wellness PAR Q

IGNITE PAR - Q
Today's Date *

- Day - Month Year
Full name *

First Name Last Name
Gender
Date of Birth *

- Day - Month Year
E-mail *
Phone Number *

- Area Code Phone Number
PART A: YOUR GOALS & CURRENT EXERCISE HABITS

1. Please select what you hope to achieve from your exercise program:

Goal *

	Yes	No
To reduce body fat
To improve aerobic capacity (heart/lung function)
To gain muscle strength and conditioning
To improve health
To tone up and improve your body image
To reduce stress

If you have another goal briefly explain -

Exercise History *

	Yes	No
Do you enjoy or participate in a sport?
Have you been exercising regularly? (i.e. more than twice a week)
Do you have any negative feelings or have you had any bad experiences with exercise programs?

If yes, please briefly explain -
PART B: HEALTH QUESTIONNAIRE (PAR-Q)

Par-Q *

	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 fain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Are you pregnant?
Are you recovering from a pregnancy or a c section?
Do you know of any other reason why you should not do physical activity?

If yes , please briefly explain -
PLEASE READ CAREFULLY
PERSONAL TRAINING

Cancellations should be given at least 12 hours notice prior to appointment time to avoid being charged the full fee.

No refunds will be given on training sessions paid for in advance. However, sessions may be transferred to a friend or family member. Ignite fitness & wellness must be notified of any health irregularities. In some cases a client may be required to undergo a Medical Examination.

In exceptional circumstances, Ignite Management may, at their entire discretion, authorise a refund. In this case, a 13.5% processing fee will be applied.
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STATEMENT

Any fitness or exercise program shall be undertaken by the Client at his/her sole risk. Ignite fitness & wellness shall not be held liable to the client, nor any person, for any claims or causes of action whatsoever arising out of or connected with the services from Ignite fitness & wellness. The Client hereby releases and discharges Ignite fitness & wellness from any such claims or action.

At all times, whilst on the premises, both property and person of the Client shall be at the Clients own risk. The client will not hold Ignite fitness & wellness or its trainers/instructors liable for any personal injury or loss of property whether caused by the negligence of Ignite fitness & wellness or its servants or agents.

Please tick here to confirm that the above questionnaire has been completed to the best of your knowledge and the terms and conditions are understood.
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IGNITE PAR - Q

PART A: YOUR GOALS & CURRENT EXERCISE HABITS

PART B: HEALTH QUESTIONNAIRE (PAR-Q)

PLEASE READ CAREFULLY

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