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PAR Q (Physical Activity Readiness Questionnaire)

It is required before partaking in our programmes to fill out the information in this questionnaire as well as read the Terms & Conditions.

Many thanks for your help in this matter.

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Question 1 of 13

Name:

Address:

Phone Number:

Email:

Year of Birth

Question 2 of 13

Select yes or no to each of the questions below.  If you select ‘yes’ you may need your doctor’s consent before you participate in our cardiovascular &/or strengthening programmes.

1. Has a doctor ever said that you have a heart condition and recommended only medically supervised activity?

A

Yes

B

No

Question 3 of 13

2. Do you have chest pain brought on by physical activity?

A

Yes

B

No

Question 4 of 13

3. Have you developed chest pain in the past month?

A

Yes

B

No

Question 5 of 13

4. Do you lose consciousness or fall over as a result of dizziness?

A

Yes

B

No

Question 6 of 13

5. Do you have a bone or joint problem that could be aggravated by physical activity?

A

Yes

B

No

Question 7 of 13

6. Has a doctor ever recommended medication for your blood pressure or a heart condition?

A

Yes

B

No

Question 8 of 13

7. Are you aware through your own experience or from doctor’s advice of any other reason why you should not exercise without medical supervision?

A

Yes

B

No

Question 9 of 13

Pre-existing medical conditions, allergies or other medical information relevant to exercise, e.g. diabetes or asthma:

 

Question 10 of 13

I realise that my body’s reaction to exercise is not totally predictable. Should I develop a condition that affects my ability to exercise, I will inform my medical professional immediately and stop exercising if necessary.  I take full responsibility for monitoring my own physical condition at all times. I understand that these programmes are followed at my own risk

 

A

Yes, I understand and please accept this as my digital signature that above information is all true and correct.

Question 11 of 13

I hereby consent to the collection and use of my personal images by photography or video recording. I acknowledge these images may be used on website, newsletters, emails or social media.   I understand my consent can be removed at any time.  

 

A

Yes, please accept this mark as my consent

B

No

Question 12 of 13

How did you hear about Adams Family UK?

(Select all that apply)
A

Social Media

B

Friend

C

Judo

D

Attended a previous class

E

Internet search

Question 13 of 13

Please read the following Terms & Conditions carefully and agree by ticking the box at the bottom. Many thanks.

 

I am voluntarily participating in physical exercise that can be strenuous and subject to risk of serious injury during PRIVATE OR GROUP TRAINING. ADAMS FAMILY UK & NEIL ADAMS EFFECTIVE FIGHTING LTD urges you to obtain a physical examination from a doctor before beginning any exercise or training program. You agree that by participating in these physical exercise sessions or personal training activities, is at your own risk. I recognize that exercise is not without some risk to the musculoskeletal system (e.g. sprain, strain) and cardiorespiratory system (e.g. dizziness, fainting, abnormal heartbeat, discomfort in breathing, abnormal blood pressure response, and in rare instances, heart attack or stroke).  I acknowledge that not all risks can be known in advance.

 

I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, “Releasor,” “I” or “me”, which terms shall also include Releasor’s parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity.

 

I HEREBY release and forever discharge ADAMS FAMILY UK & NEIL ADAMS EFFECTIVE FIGHTING LTD, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively “Releasees”), from any physical or psychological injury that I may suffer as a direct result of my participation in the aforementioned Activity.

 

I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney fees and any related costs.

 

I FURTHER AGREE to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment, field or facilities occurs as a result of my or my family’s or my agent’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any such actions of neglect or recklessness. Both participant and ADAMS FAMILY UK & NEIL ADAMS EFFECTIVE FIGHTING LTD agree that this agreement is clear and unambiguous as to its terms, and that no other evidence shall be used or admitted altering or explain the terms of this agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

 

 

(Select all that apply)
A

I have read and understood the above Terms & Conditions. I agree to adhere to what is written above.

Confirm and Submit