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Client PARQ and Disclaimer (For Your Client)

The document is a Physical Activity Readiness Questionnaire (PAR-Q) and consent form for clients before engaging in physical activity. It includes a series of health-related questions that must be answered to determine eligibility for exercise, along with a disclaimer acknowledging the risks involved. Both the client and the instructor must sign the form to confirm understanding and acceptance of the terms.

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Catalin Stoenete
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20 views2 pages

Client PARQ and Disclaimer (For Your Client)

The document is a Physical Activity Readiness Questionnaire (PAR-Q) and consent form for clients before engaging in physical activity. It includes a series of health-related questions that must be answered to determine eligibility for exercise, along with a disclaimer acknowledging the risks involved. Both the client and the instructor must sign the form to confirm understanding and acceptance of the terms.

Uploaded by

Catalin Stoenete
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Physical Activity Readiness Questionnaire (PAR-Q) form and consent form for your client

Before any physical activity can begin please complete the following questionnaire by ticking either ‘yes’ or
‘no’.

Question Yes No
Has your doctor given any reason or advised that you may not participate in any physical exercise activity? X
Have you been informed by your doctor that you have bone, joint problems e.g. arthritis that would be x
aggravated or made worse by participating in physical exercise activity?

Have you exercised regularly over the last 12 months e.g. 3 times a week? x
Are you new to exercise? x
Do you have high blood pressure? x
Do you have low blood pressure? x
Have you ever been informed by a doctor that you have raised cholesterol? x
Do you have a heart condition? x
Have you ever felt chest pains when undertaking any physical activities and or exercise? x
Are you currently taking any medication? x
Do you or have you ever suffered from unusual shortness of breath with mild exertion? x
Do you suffer from severe dizziness and or faint? x
Are you asthmatic? x
Are you diabetic? x
Are you epileptic? x
Are you pregnant? x
If you have had a baby in the last 6 weeks has your doctor/midwife given you permission to commence x
exercising?

Are you taking any medication from your doctor at present? x


Do you know of any reason why you should not participate in any physical exercise activities? x
More detail....

Fit for physical activities


Client Disclaimer
Disclaimer Information

As part of your fitness qualification with Diverse Trainers, you are required to carry out instruction of
your gym-based exercises with your chosen client.

As you are not just yet qualified, you will need to complete this Disclaimer Form for yourself and for
your chosen client to complete also.

First, please ensure your client has fully completed the Pre-Activity Readiness Questionnaire (PARQ).
If the client has answered YES to any medical conditions in the PARQ form unfortunately they will
not be able to partake in your planned activities.

You should always consult your physician or other healthcare provider before changing your diet or
starting an exercise program.

I understand that there is a risk of injury associated with participating and using the Gym.

I hereby assume full responsibility for all injuries, losses and damages that I incur while attending,
exercising or participating in exercise with the Training Instructor. I hereby waive all claims against
its instructors, or partners of individually or otherwise, for any injuries, claims or damages that I
might incur.

Client name: Nicolas Grigorie

Signed: Nick

Date: 12.02.2024

Student Name: Catalin Stoenete

Signed: 12.02.2024

Date: Catalin Stoenete

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