Bodyfaze Par-Q & Lifestyle Questionnaire

Please verify that you are human* This field is required.

Name* This field is required.

First Name

Last Name

Mobile Phone Number

Area Code

Phone Number

Emergency Contact Number

Area Code

Phone Number

Email* This field is required.

example@example.com

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

PAR-Q* This field is required.Some people should check with their doctor before commencing an exercise program, common sense is your best guide when answering this questionnaire. Please read the questions carefully and answer honestly Please mark YES or No to the following: Has your doctor ever said that you have a heart condition and recommended only medically supervised physical activity?

YESNO

Do you have pains in your chest when you perform physical activity?* This field is required.PAR-Q

YESNO

Have you had chest pain when you were not doing physical activity?* This field is required.PAR-Q

YESNO

Do you lose your balance due to dizziness or doyou ever lose consciousness?* This field is required.PAR-Q

YESNO

Do you have a bone, joint or any other health problem that causes you pain or limitations that must be addressed when developing an exercise program (i.e.diabetes, osteoporosis, high blood pressure, high cholesterol, arthritis, anorexia, bulimia, anaemia, epilepsy, respiratory ailments, back problems, etc.?* This field is required.PAR-Q

YESNO

Are you pregnant now or have given birth within the last 6 months?* This field is required.PAR-Q

YESNO

Have you had a recent surgery?* This field is required.PAR-Q

YESNO

Is your doctor currently prescribing drugs for your blood pressure or heart Condition?* This field is required.PAR-Q

YESNO

Do you take any medications, either prescription or non-prescription, on a regular basis?* This field is required.PAR-Q

YESNO

What is the medication for?PAR-Q

How does this medication affect your ability to exercise or achieve your fitness goals? PAR-Q

If you answered YES to one or more questions. Talk to your doctor BEFORE you become physically active or have a fitness appraisal. Discuss with your doctor which kinds of activities you wish to participate in. Please elaborate further.PAR-Q

If you answered NO to all the questions you can be reasonably sure that you can:

· Start becoming more physically active – start slow and build up

· Take part in a fitness appraisal – this is a good way to determine your basic fitness level. It is recommended that you have your blood pressure evaluated.

However, delay becoming more active if:

· You are not feeling well because of temporary illness such as cold or flu.

· If you are or maybe pregnant – talk to your doctor first.

Please Note: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

Have you had flu like symptoms? Did you or are you suffering any symptoms? PAR-Q

Other Health QuestionsAs overall wellness is important for us to delve a little deeper with these questions as your health and well being is of utmost importance to us. These questions are necessary if applicable. If you would like to discuss with us any of these. Please get in touch. All information provided is confidential.

Yes I have lower back pain?

Yes I have upper back pain or shoulder pain

Yes I suffer neck pain

Yes I have pelvic floor issues

Yes I wee myself on high impact exercises

Yes I have incontinence problems

Yes I suffer constipation/bowels problems

Yes I have Diastasis Recti (a condition that men & women suffer from - separation of the abdominal muscles)

Yes I have a hernia

If you have answered YES to any of the above, can you give a brief explanation below

Yes I am peri menopausal

Yes I am Post menopausal

Yes I am pregnant

Yes I have recently had a baby

Yes I had a cesarean

Yes I have osteoporosis / osteopenia / a bone condition

Yes I have/had cancer

No to the above

If you wish, please give a brief explanation if you have answered YES to any of the previous questions.

How we will contact you* This field is required.To contact you and keep you updated of cancellations, updates or events we use the following options. Please note that we CANNOT contact you if you DO NOT tick any of the options below: .

Yes I agree to be added to your mailing list?

Yes I agree to be added to your social media ie: facebook, Instagram

Yes I agree to be added to your CLOSED facebook group for tips, recipes and education?

Yes I agree to be contacted by Text

Yes I agree to be contacted by Whatsapp

Yes i agree to be added to your Whatsapp group? - this group is used only for class times and cancellations, not a chat line.

Yes i agree for you to use photographs or videos for publicity purposes? permission will be taken before hand.

No thank you

Privacy Statement* This field is required.Privacy Statement and what we do with your data In short: we respect your privacy and do not share you’re your details with anyone else. For our full Privacy policy, please see our website www.bodyfaze.com/cookie-policy/ Or this can be requested from us. Please note: Your records will be kept for 7 years from your last contact with us in accordance with ICO/GDPR regulations which came into force on the 25th May 2018 and as stipulated by our insurance company. PLEASE NOTE: If you are absent from our classes or 1:2:1's please be aware that it is in our nature to be concerned for you, the close relationships and bonds that we build mean that we will try to contact you to express our concerns. If you wish to cease training, please can you get in contact or send us an email to hello@bodyfaze.com to express your feelings and we would very much appreciate any feedback. We obviously have your well-being in mind and would welcome your return at any time in the future.

Waiver* This field is required.PLEASE READ CAREFULLYI/We agree to participate in a physical fitness regime provided by Bodyfaze,which may include, but not necessarily be reserved to, Bodyfaze. Bodyfaze has made me fully aware that the fitness regime which Bodyfaze offers, in which I agree to participate, is of a nature can be extremely strenuous and may push me to the limits of my physical abilities. I understand that the regime is not without degrees of risk which may include, but are not reserved to the following:•Injury to the musculoskeletal and/or cardio respiratory system which can result in serious injury or death.•Injury or death due to negligence on the part of myself, my training partner, or other people around me.•Injury or death due to improper use or failure of equipment.•Injury or death due to a medical condition, whether known or unknown to me.I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in the Bodyfaze training regime, and accept full responsibility for any death that may result from participation in any activity or physical exercise regime. I hereby certify that I know of no medical problems that could increase my risk of illness and injury as a result of participation in a fitness regime designed by Bodyfaze. Bodyfaze informed me that there exists the possibility of adverse physical change during an exercise regime and I fully understand the same. Bodyfaze informed me that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death. With my full understanding of the above information I agree to assume all risk associated with my participation in Bodyfaze's fitness training regime.Release of LiabilityIn full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by Bodyfaze, I hereby waive, release and discharge Bodyfaze and its employees and volunteers of any kind related to, arising from, or in any way connected with my participation in the fitness regime.This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the reminder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with Bodyfaze to administer first aid deemed necessary, and in case of serious illness or injury give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.I recognise that there is risk involved in the types of activities offered by Bodyfaze. Therefore, I accept financial responsibility for any injury that I may cause either to myself or to any other participants due to my negligence. I further agree to indemnify and hold harmless Bodyfaze, their employees and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Bodyfaze.I agree to allow Bodyfaze, its employees and volunteers to use picture(s), film and/or likenesses of me for advertising purposes. In the event I choose not to allow use of such media I must inform Bodyfaze of this in writing.I have fully read and understand the foregoing assumptions of risk and release of liability, and I understand that by signing below it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

You understand that you are taking part at your own risk. You are responsible for your own well-being and that it is very difficult for the instructor to give 1:2:1 coaching under such circumstances.

Please only work to YOUR level. You are NOT expected to overdo the exercises. Please concentrate on technique rather than how many reps you can execute.

Please look after your own safety.

If at any time you feel unwell, experience any symptoms or your health changes in any way. Please do not attend the class or tell your instructor immediatly.

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Bodyfaze Par-Q & Lifestyle Questionnaire - Classes