Membership PARQ

Full Name*

First name Surname

1. Has a doctor/medical professional ever diagnosed you with a heart condition and indicated that you should restrict your physical activity?*

Yes
No

2. Do you experience chest pains when you exercise?*

Yes
No

3. In the past 4 weeks, have you had chest pains when you were not exercising?*

Yes
No

4. Do you suffer from dizzy spells or lose your balance?*

Yes
No

5. Do you have an injury or orthopaedic condition (such as a back, hip, or knee problem) that may worsen due to a change in your physical activity?*

Yes
No

6. Do you have high blood pressure or a heart condition in which a doctor/medical professional is currently prescribing a medication?*

Yes
No

7. Are you 69 years of age or older and not used to being very active?*

Yes
No

8. Do you have insulin dependent diabetes?*

Yes
No

9. Are you, or is there any chance that you are, pregnant?*

Yes
No

10. Do you know of any other reason you should not exercise or increase your physical activity?*

Yes
No

Any additional information:

If you answer 'Yes' to any of the questions above you will be asked to seek medical advice from your GP. We will still process your membership but you will need to bring a letter of consent signed by your GP with you on your first visit.

If the answer is no to all of the above questions, you can be reasonably sure that you can become more physically active. Gym inductions are available on request by contacting us in person, by phone or email.

Declaration*

By completing this form, you confirm that you wish to participate in activities which include cardiovascular, resistance and flexibility exercises. You realise that your participation in these activities involves the risk of injury. Furthermore, you confirm that you are voluntarily engaging in an acceptable level of exercise that has been recommended to you. All information that you give will be kept confidential.

You also confirm that either you do not require a gym induction or have completed one, and that you are responsible for yourself and are able to use all equipment in a safe manner so as to not cause injury to yourself or others. Any injury inflicted will be your responsibility and this agreement releases Abingdon School Enterprises Limited from all liability relating to injuries that may occur during the use of the equipment by you.

I agree

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Membership PARQ