Personal Trainer Fitness Training - Uxbridge, Ontario

Registration Form

Please fill out the form below and press "Submit" at the bottom of the page. Fields with * are required.

General Information

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Last Name: *
Date of Birth:	(mm/dd/yyyy)
Gender:	Male Female
Address:
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Home Phone: *
Day Phone:
Email Address: *

Personal Contact

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Class Information

Class:
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Personal Activity Readiness Questionnaire (PAR-Q) PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life.

For most people, physical activity should not pose any problems or hazard. PAR-Q 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 this form carefully and check YES or NO if it applies to you. If yes, please explain.

Has your doctor ever said you have heart trouble?
Yes No	If yes, please explain.
Do you frequently have pains in your heart and chest?
Yes No	If yes, please explain.
Do you often feel faint or have spells of severe dizziness?
Yes No	If yes, please explain.
Has a doctor ever said your blood pressure was too high?
Yes No	If yes, please explain.
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?
Yes No	If yes, please explain.
Is there a good physical reason, not mentioned here, why you should not follow an activity program even if you wanted to?
Yes No	If yes, please explain.
Are you over age 60 and not accustomed to vigorous exercise?
Yes No	If yes, please explain.
Are you currently taking any medications?
Yes No	If yes, please explain.
Do you currently have a disability or a communicable disease?
Yes No	If yes, please explain.

If you answered NO to all questions above, it gives a general indication that you may participate in physical and aerobic fitness activities and/or fitness evaluation testing. The fact that you answered NO to the above questions, is no guarantee that you will have a normal response to exercise. If you answered YES to any of the above questions, then you may need written permission from a physician before participating in physical and aerobic activities and/or fitness evaluation testing with COMMIT TO FITNESS.

*Please note: If you contract a communicable disease, it is your responsibility to report it. You may be suspended from activity until your condition is cured or in a state of remission.

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