PARQ Form Please fill in the form below to complete your sign up to our fitness centre Name?(Required) Date of Birth?(Required) Day Month Year Age?(Required)Address?(Required) Postcode?(Required) Email?(Required) Tel Number?:(Required) Have you ever suffered from any of the following?Diabetes?(Required) YES NO Epilepsy?(Required) YES NO High Blood Pressure?(Required) YES NO Asthma?(Required) YES NO Heart Problems?(Required) YES NO Have you ever had the following?Back or neck pain?(Required) YES NO Serious joint injuries?(Required) YES NO Have you had a medical before?(Required) YES NO Blackouts?(Required) YES NO Please specify blackouts (if applicable): Do you smoke?(Required) YES NO Are you pregnant?(Required) YES NO Are you on medication?(Required) YES NO Have you ever had a serious illness or operation in the past?(Required) YES NO Do you currently exercise?(Required) YES NO Do you drink alcohol?(Required) YES NO Is your diet balanced?(Required) YES NO Fluid intake? How often do you exercise?(Required)Once a weekTwice a week3/4 Times a week5/6 Times a weekMore than once a dayHardly everEvery now and thenAlcohol Units intake?(Required) What do you hope to achieve?(Required) How often can you come?(Required)Once a weekTwice a week3/4 Times a week5/6 Times a weekMore than once a dayHardly everEvery now and thenHow long per session?(Required)30 Minutes45 Minutes1 Hour1 Hour 15 Minutes1 Hour 30 Minutes1 Hour 45 Minutes2 HoursMore than 2 HoursWhat time do you normally train or attend classes?(Required) Hours : Minutes AM PM AM/PM Would you be interested in hiring a personal trainer?(Required) YES NO Would you be interested in online coaching?(Required) YES NO Consent(Required) I hereby acknowledge that the information I have given on this form is full and correct. By signing the form below I declare that there is no reason that I should not participate in an exercise regime. I will participate in any exercise regime entirely at my own risk and waive any claim to legal recourse for injuries to myself or damage to my own personal property. By signing I also declare that if I have to terminate my membership at Martyn Paul Fitness Centre for any given reason I will give 1 months notice in writing and acknowledge its a minimum 3 month contract. I also take full responsibility for my own welfare while using the gym unsupervised.Signed (Client)(Required)Date?(Required) MM slash DD slash YYYY Company? (If applicable) Position? (If applicable) Δ PLEASE GIVE ONE MONTHS NOTICE IF YOU NEED TO CANCEL YOUR MEMBERSHIP
