Gym Par-Q & Induction Waiver Form

The Bourne Club Academy Tennis Padel Squash & Racketball Badminton Gym Merchandise

Par-Q & Induction Waiver Form

Forms for completion prior to using the Gym
Name(Required)
Address(Required)
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?(Required)
Do you feel pain in your chest when you perform physical activity?(Required)
In the past month, have you had chest pain when you were not performing any physical activity?(Required)
Do you lose your balance because of dizziness or do you ever lose consciousness?(Required)
Do you have a bone or joint problem that could be made worse by a change in your physical activity?(Required)
Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?(Required)
Do you know of any other reason why you should not engage in physical activity?(Required)
If you have answered “Yes” to one or more of the above questions, consult your doctor before engaging in physical activity. Tell your doctor which questions you answered “Yes” to. After a medical evaluation, seek advice from your doctor on what type of activity is suitable for your current condition.(Required)
If you answered "No" to all questions, it is reasonably safe for you to participate in physical activity, gradually building up from your current ability level. A fitness appraisal can help determine your ability levels.(Required)
Induction exercise may include: Cardiovascular machine activities e.g. Treadmill walking or jogging, cycling, rowing, cross training and stepper. I understand these exercises may exert my body, raising my heart rate and blood pressure. Resistance training using weight training machines or free weights designed to improve muscular strength and endurance. These exercises will also improve bones, joints, muscle tendons and muscle fibres.(Required)
Potential risks: Your body’s reaction to exercise cannot be predicted with complete accuracy. There is a risk of certain changes that might occur during or following exercise. These changes could relate to blood pressure or heart rate.(Required)
I confirm that I will only exercise in this gym following the safe and effective advice of the qualified fitness instructors or signing a waiver. I also understand that the gym will not always be supervised except during pre-booked Personal Training sessions. Therefore, I understand that I must take ultimate responsibility for my own condition throughout my sessions in the fitness suite. Should any unusual symptoms occur I will cease my participation and inform a member of staff immediately.(Required)
ONLY IF YOU ARE PARTICIPATING IN PERSONAL TRAINING: I agree to a representative of Core4fitness to take measurements e.g. height, weight and body composition.(Required)
The Club recognises the importance of every member undergoing an induction. This is carefully designed to ensure that the individual is made aware of the facilities and equipment available. We recommend each member undergoes an induction.(Required)
Following the aforementioned induction advice, I confirm that I am an experienced gym user and do not wish to undertake induction training. In the circumstances I understand that the Club will allow me to use the facilities, provided I seek advice from a member of staff if I am in anyway unfamiliar with a particular piece of equipment or type of exercise and I understand that I will waive certain legal rights, including the right to sue.(Required)
I require an induction and agree to you passing my details to the Club's fitness representative so that this request may be actioned(Required)
By submitting this form, I confirm that I have read, understood and accurately completed this questionnaire, I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.(Required)
If you are between the age of 14 and 17, a parent or guardian is required to counter-confirm the above information is understood and accurately correct.(Required)
If between the age of 14 and 17 please confirm Parent/Guardian Name
I am the Parent/Guardian of the aforementioned member and confirm that the information received is understand that the detail above is accurate(Required)