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LorraineMitchellFitness - PAR-Q

A health form (Physical Activity Readiness Questionnaire) to be completed BEFORE attending any group fitness classes or one:one personal training with Lorraine Mitchell Fitness

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?(Required.)
Do you feel pain in your chest when you do physical activity?(Required.)
In the past month, have you had chest pain when you were not doing 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 (for example, back, knee, or hip) that could be made worse by a change in your physical activity?(Required.)
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?(Required.)
Do you know of any other reason why you should not do physical activity?(Required.)
If you answered 'YES' to any of the above questions; please ensure that you have been given the 'all clear' by your GP that it is safe for you to exercise.  Please also liaise with Lorraine before commencing the class to confirm you have done this and that she is aware of your situation.  If you do not have this confirmation from your GP then you cannot take part in these group fitness classes and/or one:one personal training sessions with Lorraine. By ticking  the 'I confirm' box you agree to these terms.(Required.)
DECLARATION:-   I have read, understood, and completed this questionnaire.  Any questions I had were answered to my full satisfaction before completing.  I understand that I should not take part in any physical activity if I feel unwell and I declare that I am fit enough to attend and do so at my own risk.  I understand that the exercise programme is not suitable for pregnant women. I understand it is my responsibility to inform Lorraine Mitchell of any changes to my physical and mental health.  I participate in any physical activity at my own risk and waive any legal recourse for damages to myself or my property arising from my participation.  I have fully read, understood and agree to all the above.

ONLINE CLASS DECLARATION:-   I agree to ensure that I have adequate room and non-slip floor space in which to participate and that I do so at my own risk.  I will ensure that I am wearing suitable footwear, and appropriate clothing.  I understand that is is strictly forbidden to share or record the content of the online classes for my own or others use.  I confirm that I have answered honestly all of the above questions and that this form is not a substitute for a medical examination.  I confirm that I should consult my GP or medical adviser if I have any concerns for my own health.  I have fully read, understood and agree to all the above.  I agree that Lorraine Mitchell, of Lorraine Mitchell Fitness is free of any and all liability for any death, injury, illness or other health problem consequent on, or subsequent to, my participation in any of her physical activity programmes.  By submitting this form electronically back to Lorraine Mitchell via SurveyMonkey, this counts as my authorised signature. I am also fully aware that once paid, all monies are non-refundable, non-changeable and non-transferable.
Your FULL NAME & TODAY'S DATE:(Required.)