Health & Liability Form

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FROM ONE-ON-ONES TO GROUP SESSIONS

The PAR-Q is a form designed to help yourself. There are many health benefits associated with physical activity and exercise. This form is considered a sensible first step if you are planning to increase the amount of physcial activity in your life.

First & Last Name

Age

Height

Weight

Email

Phone

Select Your Package
The Fighter PackageThe Warrior PackageThe Champion PackageThe Novice PackageThe Dynamic DuoThe Party Package

Are you taking any medication or drugs?
YesNo

Do you take part in any type of physical activity, describe what you
do and how often you do it?
YesNo

Does your physician ask you to inform them before participating in
exercise?
YesNo

Do you often feel faint, have spells or feel severely dizzy?
YesNo

Do you have any underlying health conditions?
YesNo

Do you have Any injuries?
YesNo

History of chest pain or heart problems?
YesNo

Do you smoke?
YesNo

Please explain any “yes” answers:

If you answered yes to any of the questions please contact your physician by telephone or in person BEFORE taking part in any graduate exercise programs. Inform them what you answered yes to on your PAR-Q or present them a copy.

Client acknowledges the s/he is in the agreement for personal/group training services with BlayzeFitness. The Client is aware that they must pay the designated amount depending on their chosen package on or before the 1st day of training and then every month/week after whilst training with BlayzeFitness. Drop-in sessions must be paid for at least 4 hours prior to arranged time to avoid cancellation. The client is aware that it is their responsibility to come for their training and that BlayzeFitness will not refund any amount of money due to the client’s inability to attend. For emergencies only, time will be made up, but no form of payment will be refunded. Clients must act & dress appropriately in the gym facility. Clients will be held liable for any damage done to the equipment due to negligence and it will be their responsibility to pay for repairs or replacement. All clients must have personal health insurance.

Please Sign Signature Below: