PAR-Q
& YOU
For
most people physical activity should not pose any problem or hazard.
The Physical Activity Readiness- Questionnaire has
been designed to
identify the small number of adults for whom physical
activity might be
inappropriate or those who should have medical advice
concerning the
type of activity most suitable for them.
Common
sense is your best guide in answering these few questions. Please
read them
carefully and check the yes or no opposite the question if it applies
to you.
YES
NO
1.
Has your doctor ever said you have heart trouble?
2.
Do you frequently have pains in your heart and chest?
3.
Do you often feel faint or have spells of severe dizziness?
4.
Has a doctor ever said your blood pressure was too high?
5.
Has your doctor ever told you that you have a bone or joint
problem such as arthritis
that has been aggravated by exercise, or
might be made worse with exercise?
6.
Is there a good physical reason not mentioned here why you
should not follow an
activity program even if you wanted to?
7.
Are you over age 65 and not accustomed to vigorous exercise?
If
you answered YES to one or more questions...
If
you have not recently done so, consult with your personal physician by
telephone or in person before increasing your physical activity and/or taking
a
fitness test.
If
you answered NO to all questions...
If
you answered PAR-Q accurately, you have reasonable assurance of your
present
suitability for an exercise test.
PINNACLE
PERSONAL &
PERFORMANCE TRAINING
PERSONAL
TRAINING CONTRACT/
AGREEMENT
Congratulations
on your decision to work with a personal trainer. With the help of Pinnacle
Personal and Performance Training, you greatly improve your ability to accomplish your fitness
goals
faster, safer, and with maximum benefits. The details of this program are
something that can
be used for a lifetime.
In
order to maximize progress, it will be necessary for you to follow program
guidelines during
UNSUPERVISED training session. The program
guidelines are extremely important because they
will keep your program safe
and maximize its effectiveness so follow them carefully.
During
your exercise program, every effort will be made to assure your safety, but
because you
are unsupervised, following the guidelines is imperative. However,
as with any exercise program,
there are risks, including heart stress, heart
attack, and the chance of musculoskeletal injuries. In
volunteering for this
program, you agree to assume responsibility for these risks and waive any
possibility for personal damage. You also agree that, to your knowledge, you
have no limiting
physical conditions or disability that would preclude an
exercise program.
A physician’s examination is recommended for (1) all participants
with any exercise restrictions,
and (2) all persons over the age
of forty (40) years of age. Personal training participants in either
or both
of these categories who do NOT have a prior physician examination MUST
acknowledge
they have been informed of its importance.
By clicking the I ACCEPT button and typing your name(s)
below, you accept full responsibility
for your own health and well-being and
you acknowledge an understanding that no responsibility
is assumed by Pinnacle
Personal and Performance Training, or Mr. Jason Rulo.
It
must also be noted that all materials provided to the client are the
possession of Pinnacle
Personal and Performance Training, and any reproduction without his consent is
prohibited.
I
wish you the best of luck in your new personal training program!!!
- Jason Rulo Owner/Personal Trainer
Pinnacle Personal &
Performance Training
I
ACCEPT
I DO NOT ACCEPT
Participant's Name:
Parent/Guardian's
Name (if under the age of 18)
Date:
Client
Background
Date
of Birth:
Current
Bodyweight (for diet calculations):
Medical
Conditions:
Injuries/ Physical Limitations:
Fitness/ Sports Background:
Goals: