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Personal Information
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Name
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First
Last
Email
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Contact Number
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Date of Birth
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Address
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Pre-Exercise Questionnaire
Do you have or have you had any of the following?
Heart Disease or any other Cardio Vascular condition?
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Yes
No
High Blood Pressure?
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Yes
No
Any History or coronary heart disease in your family?
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Yes
No
A major Illness or surgery in last 5 years?
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Yes
No
Diabetes?
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Yes
No
Do you smoke?
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Yes
No
Arthritis or other joint/muscular pain?
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Yes
No
Asthma or difficulty breathing?
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Yes
No
Epilepsy?
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Yes
No
Dizziness, blackouts or fainting spells?
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Yes
No
Are there any other conditions or medical problems which may be reasons to modify your exercise program?
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If you have said YES to any of the above, you need a signed medical clearance from your doctor before starting exercise.
By ticking this box I warrant that I am physically and mentally well enough to proceed with online training
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Yes
Informed Consent (Risks and Benefits)
General Statement of Program Objectives and procedures:
I understand that this online personal training service may include exercises to build the cardio respiratory system (heart and lungs), the musculoskeletal system, (which involves muscular endurance, strength and overall flexibility), and to improve body composition (increasing muscle and bone and decreasing body fat). Exercise includes aerobic activities, such as walking, running, bicycle riding, rowing machine, swimming and other aerobic activities, weight lifting using dumbbells, machines and other equipment to improve muscular strength and endurance, as well as flexibility exercises to improve joint range of motion.
Description of Potential Risks:
I understand that the reaction of the heart, lung, blood vessels as well as other systems to exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during the following exercise, which include abnormalities of blood pressure or heart attacks as well as other side effects. Use of weight lifting equipment, and engaging in heavy body calisthenics may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures are not consistently followed. I understand that personal trainer (Strength Coach Glasgow) shall not be liable for any damages arising from personal injuries sustained by client (myself) while and during and/or from an online personal training program does so at his/her own risk. Client (myself) assumes full responsibilities for any injuries or damages which may occur during and/or after training.
I hereby fully and forever release and discharge personal trainer (Strength Coach Glasgow), its assigns and agents from all claims, demands, damages, rights of action, present and future therein.
I understand and warrant, release and agree that I am in good physical condition and that I have no disability, impairment or ailment preventing me from engaging in active or passive exercise that will be detrimental to heart, safety, or comfort, or physical condition if I engage or participate (other than those items fully discussed on this form).
I state that I have had a recent physical check up and have my personal physician’s permission to engage in aerobic and/or anaerobic conditioning.
Description of Potential Benefits:
I understand that a program of regular exercise for the heart, lungs, muscles and joints has many benefits associated with it. These may include a decrease in body fat, improvement in blood fats and blood pressure, improvement in physiological function and decrease in heart disease.
I have read the foregoing information and understand it. Any questions, which may have occurred, have been answered to my satisfaction.
Have Your Read and Understood the Above?
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Yes, I give my full informed consent to Proceed and waive any liability
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I agree to receiving marketing and promotional materials
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