PAR-Q Health Questionnaire
Answer all 7 questions honestly. If you answer YES to any question, we strongly recommend physician clearance before starting.
Q1
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Please obtain written clearance from your physician before starting.
Q2
Do you feel pain in your chest when you do physical activity?
Please obtain written clearance from your physician before starting.
Q3
In the past month, have you had chest pain when you were not doing physical activity?
Please obtain written clearance from your physician before starting.
Q4
Do you lose your balance because of dizziness or do you ever lose consciousness?
Please consult your physician before starting any exercise program.
Q5
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
We'll note this and program around it. Your coach will follow up before your first session.
Q6
Is your doctor currently prescribing drugs for your blood pressure or heart condition?
Please obtain written clearance from your physician before starting.
Q7
Do you know of any other reason why you should not do physical activity?
We'll follow up to understand more before you get started.
Liability Waiver
ASSUMPTION OF RISK AND LIABILITY WAIVER
I, the undersigned participant, acknowledge that I am voluntarily participating in a fitness program operated by Carl Simpson / Real Lyfe Fitness ("the Program"). I understand that physical exercise involves inherent risks, including but not limited to physical injury, illness, and in extreme cases, death.
I hereby affirm that I am physically fit and have no medical condition that would prevent my participation in fitness activities, or that I have obtained appropriate medical clearance prior to participation. I agree that if at any point during my participation I feel any pain, unusual shortness of breath, dizziness, or discomfort, I will immediately cease participation and consult a physician.
I, for myself, my heirs, executors, administrators, assigns, and legal representatives, hereby release, waive, discharge, and covenant not to sue Carl Simpson, Real Lyfe Fitness, its officers, agents, employees, and successors from all liability, claims, demands, losses, or damages on account of personal injury, property damage, or otherwise, caused or alleged to be caused in whole or in part by the negligence of Carl Simpson / Real Lyfe Fitness.
I acknowledge that I have read this waiver, understand it, and sign it voluntarily. This agreement shall be binding upon me, my heirs, executors, administrators, and assigns.
I have read and agree to the Liability Waiver above *
You must agree to continue
Signature required
After submitting you'll be taken directly to sign up for Real Start.