PARQ - Adults - Iron Skull Gym

1Your personal details

2Medical information

3Emergency contact

4Declaration

5Training Declaration

Name(Required)

First Last

Date of Birth(Required)

Day

Month

Year

Gender(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City Post Code Country

Has your doctor ever advised you not to participate in physical activity without their recommendation ?(Required)

Yes

Further details(Required)

Please give further details why your doctor advised you not to participate in physical activity

Do you suffer from, or have you suffered from any of the following conditions(Required)

Angina, Heart attack, Other heart condition, Chest pains, Breathlessness, Stoke, Asthma, Diabetes, Epilepsy, Allergy, Dizziness, Loss of consciousness, Arthritis, Cholesterol problems, Blood pressure problems or Bronchial problems.

Yes

Further details(Required)

Please give further details on your condition / conditions

Do you have any pain / complaint in the following areas(Required)

Feet, Ankles, Lower leg, Knees, Upper legs, Hips, Back, Shoulders, Neck, Head, Elbows, Hands or anywhere else?

Yes

Further details(Required)

Please give further details on your where you have pain

Have you had any sprain or strain injury in the last 18 months?(Required)

Yes

Further details(Required)

Please give further details on your sprain or strain injury and what treatment you received (if any)

Does exercise aggravate any condition or injury(Required)

Yes

Further details(Required)

Please give further details on exercise aggravating any condition or injury

Is your doctor currently prescribing you any medication?(Required)

Yes

Further details(Required)

Please give further details on the medication you are being prescribed

Are you pregnant or have you given birth in the last 6 weeks?(Required)

Yes

Do you know of any reason why you should not participate in any physical activity?(Required)

Yes

Further details(Required)

Please give further details on why you should not participate in physical activity

Name(Required)

First Last

Relationship

Phone / Mobile(Required)

Email(Required)

Declaration(Required)

I have read and understood the questions in this form and have answered them honestly and to the best of my knowledge.

I understand that if I have answered yes to any of the questions in this form then I will need to discuss the details with my personal trainer and may be asked to talk with my doctor before commencing a any class.

I agree to inform instructor trainer should my health change so that I can answer yes to any of the above questions.

I have read and understood the above

Assumption of Risk & Waiver of Liability(Required)

The student or member represents that he/she is in good physical condition and is able to use the training equipment provided by Strength Gym LTD trading as Iron Skull Gym. Student/Member hereby acknowledges that he/she is fully aware of the risks and hazards inherent in the practice of martial arts and in fitness activities and hereby assumes voluntarily all risks of loss, damage or injury (including death) that may be sustained by Student/Member or to his/her property. Student/Member hereby accepts full responsibility for the use of, or participation in, any and all classes, services, equipment, demonstrations or events, whatsoever owned, operated or sponsored by Strength Gym LTD trading as Iron Skull Gym, whether on-site or off-site and hereby releases and agrees to hold harmless, Strength Gym LTD trading as Iron Skull Gym, its owners, officers, directors, members, employees, representatives and agents from any and all loss, claim, injury, damage or liability sustained or incurred by Student/Member resulting there from. This release shall be binding upon the heirs, distributes, next of kin, executor and administrator of each of the undersigned. In signing this Agreement, the undersigned hereby acknowledges and represents that he/she has read this release, understands it and signs it voluntarily.

I have read and understood the above

Data Protection(Required)

Strenght Gym LTD collects and processes information about club members. The Data Protection Act 1998 requires Strenght Gym LTD to obtain your agreement before this can be done. In signing this form you are giving consent for your personal and sensitive information to be processed under the rules and safeguards laid down by the 1998 Act. Strenght Gym LTD has procedures in place to ensure that all information held about you will be dealt with confidentially, held securely and only processed in accordance with Strenght Gym LTD’s notification to the Information Commissioner, who administers the Act.

I Agrree

Declaration of Acceptance to undertake Training at Iron Skull Gym

1(Required)

I accept to undertake the forthcoming training and I have made the instructors aware of any personal limitations I may have with regard to undertaking physical skills training and I have completed the medical questionnaire highlighting any physical injuries or issues with regard to my health that the instructors should be aware of;

I Agrree

2(Required)

I accept that no physical activities or sports training can offer a complete guarantee of safety and that there is a risk involved with regard to injury on undertaking such training;

I Agrree

3(Required)

I will at all times conduct myself with due regard to my health and safety and the health and safety of others on the course and I will obey lawful instructions given to me and comply as far as practicable with the safety briefs provided for my safety;

I Agrree

4(Required)

If I am injured during the training I will immediately bring this to the attention of the instructors.

I Agrree

5(Required)

If I am injured during the training I will immediately bring this to the attention of the instructors.

I Agrree

7(Required)

I will abide by all lawful instructions given by the instructors or any other delegate nominated by the instructors;

I Agrree

6(Required)

I will at all times take whatever action is necessary to reduce or eliminate the risk of injury to myself and others by undertaking the training in accordance with the safety instructions and briefings provided for the safety of myself and others;

I Agrree

7(Required)

I will not attempt to teach any technique shown to me during the training without the express permission and relevant instructor education from Iron Skull Gym;

I Agrree

8(Required)

I accept that if I act in any intentionally negligent way that compromises my safety or the safety of others or which causes harm to myself or others I may be removed from the training immediately at the discretion of the instructors;

I Agrree

9(Required)

I will bring to the attention of the instructors anything that I feel is a risk to any person (including the instructors), which comes to my attention during the training. This also involves any actions by others who I honestly feel may seriously compromise the health and safety of others. I expect any such forthcoming information to be treated with due regard to privacy and in a confidential and professional manner.

I Agrree

PARQ Form

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Training

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Kids & Teens (Ages 4–16)

Adults (16+)

PARQ Form

Info

Training

Our Location

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Who’s training?

Kids & Teens (Ages 4–16)

Adults (16+)

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