CHILD PARQ

    PARENT/GUARDIAN DETAILS

    Full Name (required)

    Address

    Phone Number

    Email Address

    Relationship to Child

    CHILD DETAILS

    Full Name (required)

    Date of Birth

    Address (if different to above)

    Phone Number (if applicable)

    Secondary Emergency Contact Name

    Secondary Emergency Contact Number

    Relationship to Child

    CHILD HEALTH QUESTIONNAIRE

    Parent/guardian should complete these questions on behalf of the child. We recommend that you do this together with the child. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly.

    1. Has your Doctor ever said you should NOT take part in physical activity? YesNo
    2. Enter more info here if yes

    3. Has your Doctor ever said that you have a heart condition? YesNo
    4. Enter more info here if yes

    5. Has your Doctor ever said that you have high/low blood pressure? YesNo
    6. Enter more info here if yes

    7. Are you taking any medication for your blood pressure or heart condition? YesNo
    8. Enter more info here if yes

    9. Do you have Diabetes Mellitus or any other form of Diabetes? YesNo
    10. Enter more info here if yes

    11. Do you, or have you recently felt pain in your chest when doing physical activity? YesNo
    12. Enter more info here if yes

    13. Do you ever lose balance, become dizzy or ever lose consciousness? YesNo
    14. Enter more info here if yes

    15. Do you have any injuries that could be aggravated by exercise? YesNo
    16. Enter more info here if yes

    17. More specifically, do you have any joint problems including back, knees and/or neck? YesNo
    18. Enter more info here if yes

    19. Has anyone in your immediate family had a heart attack prior to the age of 55 years? YesNo
    20. Enter more info here if yes

    21. Has your Doctor ever said you have raised cholesterol levels? YesNo
    22. Enter more info here if yes

    23. Have you ever been short of breath, had difficulty breathing or been diagnosed with asthma? YesNo
    24. Enter more info here if yes

    25. Do you suffer from Epilepsy? YesNo
    26. Enter more info here if yes

    27. Are you or do you think you may be, pregnant? YesNo
    28. Enter more info here if yes

    29. Have you had or are you in recovery from any major surgery including pregnancy in the last 6 months? YesNo
    30. Enter more info here if yes


    Is there any other reason, medical or otherwise that may affect your ability to exercise? If yes, please comment below

    Enter more info here if yes

    INDIVIDUAL NEEDS ASSESSMENT

    1. A: I prefer to build up slowly so I don’t feel overwhelmed.
      B: I like to hit it hard from the start. Option AOption B

    2. A: I want a personal trainer who will push me to my limit.
      B: I want a personal trainer who won't hurt my confidence. Option AOption B

    3. A: I’d love to have a fantastic body and I'm prepared to do whatever it takes.
      B: I’d just like to lose a few pounds and keep them off. Option AOption B

    4. A: My main motivation is to look good and feel good about how I look.
      B: My main motivation is good health. Option AOption B

    5. YOUR CURRENT TRAINING

      1. A: I am relatively experienced with bodyweight exercises, such as squats, lunges and sit ups.
        B: I am inexperienced with bodyweight exercises.Option AOption B

      2. A: I am relatively experienced with resistance training exercises, such as barbell squats, bench press and deadlift.
        B: I am not experienced with resistance training exercises. Option AOption B

      3. A: I am comfortable with running.
        B: I am not comfortable with running. Option AOption B


      DECLARATION

      I understand that if the child's health changes so that I then answer YES to any of the above questions, I will inform the trainer and ask whether I should change the physical plan.

      I understand that Reach Fitness strongly advise that if the child has not participated in regular physical exercise prior to beginning this activity, they should seek advice from a doctor.

      I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish my child to participate in activities, which may include aerobic exercise such as running, jumping and rowing, resistance exercise (including but not limited to barbells, dumbbells, kettlebells and various weight-training equipment) and stretching. I realise that my the child's participation in these activities involves the risk of injury and even the possibility of death.

      Furthermore, I hereby confirm that I am voluntarily engaging the child in an acceptable level of exercise, and that I should consult a doctor if the child is suffering from any condition that might make physical activity injurious to my health.

      I understand that the responsibility of the child's fitness to participate rests with me. I agree to abide by any verbal or written instruction given by my trainer. I declare that to the best of my knowledge this information is correct and that I will notify the trainer of any changes in the child's medical condition.

      I understand the results of any fitness program cannot be guaranteed and the child's progress depends on their effort and cooperation in and outside of the sessions.

      I understand that during a training session, my child's trainer may have to use Touch Training to correct alignment and/or to focus my concentration on a particular muscle area to be targeted. If will discuss with my child that if they feel uncomfortable or experience any type of discomfort with Touch Training, they or I will immediately request that my trainer discontinue using this technique.

      I understand that Reach Fitness may photograph and/or film their client events/sessions and I agree to allow them to use these pictures, films, and/or likenesses of my child for promotional purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform Reach Fitness of this in writing.

      I understand that my child is not obligated to perform nor participate in any activity that they do not wish to do, and that it is my child's right to refuse such participation at any time during a training sessions.

      I understand that I will discuss with the child that if they feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, they are to stop the activity and inform the Trainer.

      I agree that Reach Fitness shall not be liable or responsible for any injuries to the child resulting from their participation in the fitness program (whether at home, at the training studio, outdoors, or at a corporate, commercial, residential or other fitness facility) and I expressly release and discharge Reach Fitness and its owners, employees, agents and/or assigns, from all claims, actions, judgements and the like which I or my heirs, executors, administrators or assigns may have or claim to have as a result of any injury or other damage which may occur in connection with the child's participation in the fitness program, excepting only an injury caused by the gross negligence or intentional act of such person or persons. This Release shall be binding upon my heirs, executors, administrators and assigns.

      I Agree that I have read and agree to the statements above

      TERMS & CONDITIONS

      Cancellation Policy: A 24 hour cancellation policy applies to scheduled sessions. Sessions cancelled or rearranged less than 24 hours in advance will be charged in full to the client. If a session is cancelled within 24 hours by the personal trainer, a complimentary session will be offered. All packages are non-refundable and must be taken within 16 weeks of payment.

      Bank Holidays: Sessions will not take place on a bank holiday or the weekend of a bank holiday.

      - 6/8/12 Week PT Packages: If a training session falls on a bank holiday then the session will be rescheduled at the convenience of both the client and trainer, or “rolled over” to the end of the current package.

      - Monthly PT Packages: Bank holidays are factored into the pro-rata price so therefore there will be no training on bank holidays.

      - Group PT Packages: The bootcamp isn't priced based solely on the number of sessions - it's the whole package. In fact, the true value of the bootcamp isn't just in the sessions (bootcamps are ten a penny) it's in the ongoing support and expert nutrition advice that we provide. That's why we don't price it per session because we really believe that we are much more than that. Bootcamp courses are priced as a whole package, and not per session, therefore there will be no training on bank holidays.

      I Agree that I have read and agree to the terms and conditions