PAR-Q Brani

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Health Questionnaire

Please read the following questions carefully and answer each one honestly. Take your time and make sure you understand each question before you answer. If you have any questions, please ask for advice.*

	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?
In 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 a heart condition or other serious illness?
Have you had surgery in the past 6 months, if so give details.
Are you pregnant or have you been pregnant within the last 5 months?

If you answered 'YES' to any above, please give details.

The Contraindications

Do you know of any other reason (including the following) why you should not do physical activity?

Absolute Medical Conditions

*Acute diseases / Inflammation processes
*Wearing a pacemaker
*Acute thrombosis conditions
*Fresh wounds resulting from an operation or surgical intervention
*Pregnancy
*Osteoporosis in an advanced stage

Non-absolute Medical Conditions

*Migraine / Epilepsy / Retinal *Problems
*Acute hernia, discopathy, spondylolysis
*Cardio-vascular disease
*Wearing recently fitted IUD’s, coils, metal pins, bolts or plates
*Gall and kidney Stones
*Synthetic joints

If any of above or other reason applies to you, write here.

Any other information you might feel is relevant:

If you have answered yes to any of the above questions, then you are required to gain consent from your doctor before participating in the park/gym-based programme.

If you have answered NO to all of the above questions and you have reasonable assurance of your suitability for:

A park/gym-based exercise programme – which will include all or relevant; a warm up, cardiovascular training including using equipment, fixed weights, using resistance machines, free weights, using dumbbells and barbells, kettlebells, any other fitness equipment and area relevant constructions, body weight exercises and cool down stretches.

You are advised to postpone entry into the programme if you feel unwell or have a temporary illness. You must inform your gym instructor of any changes to your health status, whilst engaged in your training programme.

CONSENT: I confirm that I have read & understood the Contraindications (none of which apply to me), the Informed Consent wording and have answered ‘no’ to all questions in the Health Questionnaire. I confirm that I will notify the trainer if there is any change in my health or circumstances, which might impact on my ability to attend any training session with Paulina Szymanska.

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Client informations - Liability Waiver

I am aware of the risks in observing or participating in the activities offered by Paulina Szymanska - Personal Trainer 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 Paulina Szymanska - Personal Trainer is responsible for any damage that would be resulting from a fault of Paulina Szymanska - Personal Trainer.

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 100% of a regular price session for the cancellation.

Paulina Szymanska - Personal Trainer understands that emergencies happen. I 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 Paulina Szymanska - Personal Trainer is notice prior to the session start time. No show are not eligible for the free cancellation.

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