PARTICIPANT INFORMATION SHEET

 

 

Address:

 

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

 

 

If you have answered “Yes” to one or more of the above questions, consult your physician before engaging in physical activity.  After a medical evaluation, please seek advice from your physician on what type of activity is suitable for your current condition.

 

Please also advise of (and explain below) any health conditions you have now or have had in the past which may be relevant to your ability to participate in an exercise class, including but not limited to:

 

 

 

 

 

 What is your favorite type of exercise and your least favorite (and why)?

 

 

 

If weight loss (or gain) is one of your goals and you are comfortable sharing the information, please maintain a full and honest (i.e., representative) food diary for at least two complete days prior to our next meeting.  Please include every bite and taste (including all beverages and water). 

(Feel free to email your completed food log to java@javafitness.com or bring to your first class/session.)

 

Liability Waiver:

 

, (1) understand that there are risks inherent in any type of physical activity; (2) represent that I am in good physical condition and have no disabilities, diseases, illnesses or other conditions that could prevent me from participating in an exercise program without injuring myself or impairing my health; and (3) represent that I have consulted a physician who has approved my participation in an exercise program of this nature.  Should injury occur while participating in this class, I agree to hold Java Fitness, LLC and its employees harmless for any such injuries.

 

 

 

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Signature      (to be signed before class)  

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Date

 

All material provided on the Java Fitness web site is provided for informational or educational purposes only. You should not rely on this information as a substitute for, nor does it replace, consultation with and advice by your physician or other personal health-care professional.  Please consult with your physician before undertaking any exercise or weight-loss program.