Your DetailsFirst Name *Last Name *DOB *DaySelect day12345678910111213141516171819202122232425262728293031MonthSelect month123456789101112YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924Email Address *Contact NumberAddressStreetCityPostal CodeEmergency Contact DetailsFirst Name *Last Name *Emergency Contact *The Physical Activity Readiness Questionnaire (Par-Q)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 much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions 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 you best guide when you answer these questions. Please read the questions carefully and answer each one honestly by checking YES or NO.1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *Please select an option?YesNo2. Do you feel pain in your chest when you do physical activity? *Please select an option?YesNo3. In the past month, have you had chest pain when you were not doing physical activity? *Please select an option?YesNo4. Do you lose your balance because of dizziness or do you ever lose consciousness? *Please select an option?YesNo5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? *Please select an option?YesNo6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *Please select an option?YesNo7. Do you know of any other reason why you should not do physical activity? *Please select an option?YesNoAdvice: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.General Statement of Program Objectives and Procedures *I understand that this physical fitness training/competition includes exercises to build/exercise the cardiorespiratory system (heart and lungs), the musculoskeletal system (muscle endurance and strength, and flexibility), and to improve body composition (decrease of body fat in individuals needing to lose fat, with an increase in weight of muscle and bone). Exercise may include aerobic activities (walking, running, bicycle riding, group aerobic activity, and other aerobic activities), callisthenic exercises, and weight lifting to improve/test muscular strength and endurance and flexibility exercises to improve joint range of motion. Exercise may also include the use of undulating ground and areas of countryside that may contain livestock, the use of obstacle equipment and objects that are carried. Please note that while we take every precaution to minimise risk of the coronavirus pandemic we do not accept liability and you assume full responsibility for your own health while on centre. You are coming knowing the risks associated to the pandemic and are agreeing that you have visited in full health as far as your knowledge allows.Description of Potential Risks *I understand that the reaction of the heart, lung, and blood vessel system to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or following exercise which may include abnormalities of blood pressure or heart attacks. Use of the 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 followed. When using land used by livestock and other wild animals such as foxes there may be potential hazards associated with those animals which may cause sickness or similar. I understand that Rumble Fitness (seller) shall not be liable for any damages arising from personal injuries sustained by client (buyer) while and during the training program not excluding any sickness related to use of the land and natural environments. Client (buyer) using the exercising equipment during the personal training program does so at his/her own risk. Client (buyer) assumes full responsibility for any injuries or damages which may occur during any training and events. I hereby fully and forever release and discharge Rumble Fitness (seller), its assigns and agents 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. I state that I have had a recent physical check-up and have my general practitioners’ permission to engage in aerobic and/or anaerobic conditioning. I also give my consent for Rumble Fitness to take photographs / video and use in any relevant social media or marketing strategy they deem suitable.Description of Potential Benefits * 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 to me have been answered to my satisfaction.Signature *By checking this you are agreeing to all of the above information and terms. Your information will be kept on record for use in an emergency, direct contact from Rumble Fitness and its agents and we do not sell or pass on your details to any other company or business. We will continue to keep this record on file for 5 years after signature. You have a right to withdraw your permission for use of your personal details in direct contact from ourselves and also the use of footage and photographs of yourself in our marketing strategies etc. If you desire to do so we ask you to do so in written format via email or letter. Complete ParQPlease do not fill in this field.
