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SC-FITNESS
PERSONAL TRAINER CARDIFF
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SC-Fitness Online Classes PAR-Q
Name
*
First Name
Last Name
Email
*
Date of Birth
*
MM
DD
YYYY
Emergency Contact Details
*
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
*
Yes
No
Do you feel pain in your chest when you do physical activity?
*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?
*
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
*
Yes
No
Do you know of any other reason why you should not do physical activity?
*
Yes
No
If you answered YES to one or more questions, please write more details here. You may also need to talk with your doctor by phone BEFORE you start your exercise programme.
*
I confirm that I am taking part in any live online fitness classes run by SC-Fitness at my own risk and take full responsibility for my own safety during these classes.
*
I confirm that I am happy for SC-Fitness Personal Training to store my personal information and data as long as it is necessary to the service I will receive in line with the GDPR act 2018.
*
Yes
No
Signature
*
To confirm that you agree to the above statements and that you are happy to participate in online classes with SC-Fitness.
Thank you!