Adult PARQ

As you have advised that you are currently experiencing this listed contraindication a medical certificate/letter from your GP will be required before you commence physical activity. When you are in receipt of your medical certificate/letter please contact the Centre to arrange your induction

Coronary heart disease

Yes

Uncontrolled diabetes

Yes

As you have advised that you are currently experiencing this listed contraindication, an induction/consultation will be required with one of our exercise professionals. Please feel free to add any further details you wish to provide on the condition, which may assist our instructors in the prescription of a suitable exercise programme for you.

COPD, Asthma or other respiratory problems

Yes

A bone, joint or muscular problem

Yes

Has your doctor ever advised you not to exercise

Yes

Is there any reason not mentioned above why any type of physical activity may not be suitable for you

Yes

If you answered yes to any of the previous questions, please write full details here:

As part of our commitment to all new members, prior to commencing use of our fitness suites an induction is available and encouraged. This contributes to ensuring that Council are creating a safe environment for your training requirements.

Do you require an induction?

Yes

No (Self declared competent)

Council recognise that some new members may be experienced fitness suite users, and would prefer to opt out of the offer of an induction. By not accepting the offer of an induction, you accept responsibility for any injury you may sustain from incorrect use of the equipment. We also ask that, you follow the rules within the fitness suite, you use the equipment in a safe manner and you inform a member of staff of any changes to the medical conditions listed

Declaration

I have read and understood this form and confirm that the answers provided are correct.

I accept that if any of the answers to the questions on this form change, it is my responsibility to inform a Fitness Instructor and/or seek approval from my doctor before continuing to exercise.

I accept that I am responsible for monitoring myself throughout any activity and if I experience any unusual symptoms I will cease the activity and inform a Fitness Instructor.

I commit to abide by the rules and regulations of the facility and to behave in a polite and social manner whilst attending.

Details

Emergency Contact Numbers

Health Questions