PAR-Q & Client agreement

About you

First name *

Last name *

Email address *

Phone *

Date of birth *

Day

Month

Year

Street Address

City

Postcode

Country

Lifestyle

Occupation *

How Active Is Your Job? *

Health history

Age *

Height (in metres) *

Weight (in kg) *

Are you pregnant? *YesNo

Have you had a baby in the last 6 months? *YesNo

If yes, how long ago?

Are you breastfeeding? *YesNo

Did you have any complications with your pregnancy or after birth, such as a prolapse or separation of stomach wall (Diastasis Recti)Please also include what type of birth you had - natural/C-section

Do you have high, low or normal Blood Pressure? *Please expand

Do you have high, low or normal Cholesterol? *Please expand

Have you had any surgery recently? If yes what for? *

Do you have any injuries that would prevent you from certain exercises (such as high impact exercises) *

Have you ever had an eating disorder? *

Are you currently taking any medication? If yes, what is it and what are you taking for? *

What are your goals? *

Terms and conditions

By checking this box, I agree to the terms laid out in the Terms and Conditions for the services I'm using.

Physical Activity Readiness Questionnaire (PAR-Q)

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 significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor. Common sense is your best guide when answering these questions please read carefully and answer each one honestly: check YES or NO.

Has your doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor? *YesNo

Do you feel pain in your chest when you do physical activity? *YesNo

In the past month, have you had a chest pain when you were not doing physical activity? *YesNo

Do you lose your balance because of dizziness or do you ever lose consciousness? *YesNo

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? *YesNo

Is your doctor currently prescribing medication? (for your blood pressure, heart condition etc?) *YesNo

Do you suffer from Asthma? *YesNo

Do you suffer from Epilepsy? *YesNo

Do you know of any other reason why you should not do physical activity? *YesNo

If yes, please comment:

Signed *

In consideration of being able to take part in exercise and physical activity organised by ace lifestyle, I acknowledge that I am physically fit for participating in ace lifestyle activities. I agree to abide by all verbal and written notices regarding safety whilst exercising with ace lifestyle. ace lifestyle shall not be liable for any injury or death I may suffer in these activities.

Full name *

24 Hour notice *

I, the client, agree to give 24 hours notice for cancellation of sessions. I understand that if 24 hours notice is not given, the fee for that session will stand. With group session, it is the responsibility of all participants to cover the cost of the session in full if 1 participant cancels within 24 hours.

Late arrivals *

I, the client, understand that if I am not on time for a session(s), the session(s) may be cut short and the full fee applied.

Credit for missed session *

I, the client understand that if I receive credit for a missed session, the credit must be used within 60 days of the missed session, or it will be waived.

Payments *

I, the client, understand that failure to make payments within one month will result in the cancellation of the program.

Fitness *

I, the client, understand that the outcome of any fitness program will be due to the work that the participants do, what the participants’ abilities are, and their genetic makeup. The factors outside of the personal training sessions are beyond the control of the trainer.

Rates *

I, the client, understand that rates for ace Lifestyle are subject to change. Prepaid services by the client, which are unused at the time of rate change, will be honoured at the prepaid price.

Emergency *

I, the client, understand that by signing this, I am also giving permission for the trainer to contact emergency services during an emergency situation if he or she sees fit.

Rules *

I, the client, agree to observe any and all rules of the gym or facility where workouts take place, if applicable.

Injuries & limitations *

I, the client, understand that I have control of the workout and may terminate a particular exercise or workout at any time. If a particular exercise is painful for you to do or you have an injury or other limitation that makes it difficult for you to do, your trainer can attempt to substitute another exercise to work that particular muscle group.

Workout session *

I, the client, agree that the trainer can terminate a particular exercise or workout at any time if the trainer believes I am not in suitable condition for exercise—for example, if I, the client, am noticeably under the influence of drugs or alcohol, disclose the fact that I have abused drugs or alcohol medications or if I have not eaten anything in reasonable amount of time pre-workout, etc.

Signed *

Full Name *