PAR-Q & LIABILITY WAIVER

Medical History

Have you ever suffered with Epilepsy?
Are you pregnant?
Have you ever suffered from heart trouble?
Are you presently taking any form of medication?
Do you suffer from chest pains?
Do you ever have spells of dizziness or feel faint?
Have you ever had either high or low blood pressure, and/or high cholesterol?
Have you ever had asthma, chronic bronchitis or any other chest ailments?
Do you suffer from severe back pains or any orthopaedic problem?
Do you suffer from severe headaches or migraines?
Are you recovering from a recent illness / operation or injury?
Have you any medical condition that we should be aware of?
Is there any history of heart disease in your immediate family (before age 55)?
Have you an pre-existing or previous injuries or medical conditions which may restrict you from fully participating in a fitness activity?
Have you ever been under the care of a medical doctor, consultant, physiotherapist of chiropractor for any existing or previous medical injuries or conditions?

PLEASE NOTE: If you have answered YES to any questions 1 - 15, you are advised to seek medical advice/approval before taking part in this class.

I have been informed that if I answer YES to any of the questions 1 - 15 of the questionnaire I should seek medical advice/approval before commencing this class. If I wish to continue without such advice I do so entirely at my own risk.

I confirm that I have read, fully understood and answered honestly and have read the Risk Assessment for this venue.

I understand that if any of the above answers change it is my responsibility to inform the Instructor/coach prior to commencing a personal trainer session.I understand that if I am absent from session and return due to illness I will inform the instructor/coach of my illness prior to commencing a training session.

I understand the nature of a reformer bed session and confirm that I am in proper physical and mental condition to participate. If at anytime I have questions, feel unsafe or unwell I will immediately inform the Instructor/coach and discontinue further participation in the session.

I understand that neither the Instructor/instructors or EmPower Wellness Studio, can be held responsible for any injuries or ill health of any kind arising from participation within this session.

You can also find the Empower Wellness Studio Terms and Conditions here, for further information.