Gym health questionnaire Form Template

Welcome sheet - Client informations
Full name *

First Name Last Name
Birth Date *

Month Day Year

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number *

- Area Code Phone Number
Emergency contact *

First Name Last Name
Phone number *

- Area Code Phone Number
Clients informations - Health questionnaire (Par-Q)
Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

Par-Q *

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel fain in your chest when you do physical activity?
n the past month, have you had chest pain when you were not doing physical activity?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction
Initials *

Clear
Client informations - Liability waiver
I am aware of the risks in observing or participating in the activities offered and sponsored by Vsquarefitness and I understand that all sports or fitness that I will execute and participate in are entirely at my own risk and perils. I assume complete responsibility and liability for those risks and for the injuries that may occur as a result of these risks, even if injuries occur in a manner that is not foreseeable at the time I sign this agreement. I realize that by voluntarily assuming the risks involved, I will be solely responsible for any loss or damage I sustain, including personal injuries to me, damage to my property, or damage arising out of my death. It is understood that Vsquarefitness is responsible for any damage that would be resulting from a fault of Vsquarefitness and its representatives.
Initials *

Clear
Client informations - 24h cancellation policy
All cancellations must be received at least 24h before your training session in order to avoid being charged. Clients who do not cancel with 24h notice will be charged 50% of a regular price session for the cancellation.

VSQUAREFITNESS understands that emergencies happen. We provide every client with one free short-notice cancellation. You will not be charged for your first cancellation with less than 24h notice. Subsequent short notice cancellations will be charged for the session. The free short-notice cancellation only applies if VSQUAREFITNESS, or your trainer is notice prior to the session start time. No show are not eligible for the free cancellation.
Initials *

Clear

Client informations - Billing policy
I authorize Vsquarefitness to bill my credit card every last day of the month for the services provided during that month.
Initials *

Clear
Client informations - Signature
Signature *

Clear
Date

- Jour - Mois Année
at
: hi me messaoud Minutes
Should be Empty:

Gym health questionnaire Form

Welcome sheet - Client informations

Clients informations - Health questionnaire (Par-Q)

Client informations - Liability waiver

Client informations - 24h cancellation policy

Client informations - Billing policy

Client informations - Signature