Gym PAR-QGym PAR-Q You need to fill this in every year, so we have up-to-date medical information on your fitness to use the gym and can provide appropriate advice.Gym UserName* First Last Email* Date of birth* Day Month YearCurrent age* 12-15 16-17 18+Medical questionsBefore significantly changing your exercise patterns, please check with your doctor. Please also answer the following questions:Has your Doctor ever said you have a heart condition and that you should only do physical activity recommended by a Doctor?* Yes NoDo you feel pain in your chest when you do physical activity?* Yes NoIn the past month, have you had a chest pain when you were not doing physical activity?* Yes NoDo you lose balance because of dizziness or do you ever lose consciousness?* Yes NoDo you have a bone or joint problem (for example back, knee or hip) that could be made worse by a change in your physical activity?* Yes NoIs your Doctor currently prescribing medication for your blood pressure or a heart condition?* Yes NoDo you know of any other reason why you should not do physical activity?* Yes NoAre you usually inactive, doing very little exercise?* Yes NoHave you checked with your Doctor that it is safe for you to become physically active at this current time and in your current state of health?* Yes NoIf you have answered yes to any of these questions, please provide further information here:Please tell us about your training needs and goals:Instructor's advice to the client:To be filled in during the inductionAdditional document uploadTo be added by the gym instructor, if needed. Drop files here or Select filesMax. file size: 256 MB, Max. files: 3. It might not be safe for us to induct you at the momentPlease consult your Doctor to clarify if it is safe for you to become physically active at this current time and in your current state of health. Then if your Doctor says yes, please fill in this form again and we will arrange an induction. If you want to discuss this, please contact us at gym@penistoneleisurecentre.org.uk.We can arrange for an induction for youIt is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.We can arrange for an induction for youIt is reasonably safe for you to participate in physical activity, gradually building up from your current ability level.Conditions of UsePlease agree to the below:I have read, understood and accurately completed this questionnaire* YesI confirm that I am voluntarily engaging in an acceptable level of exercise and my participation involves a risk of injury. I am responsible for my own safety and wellbeing.* YesI acknowledge that there is not always a gym instructor present while I am exercising* YesI agree that disruptive / anti-social / illegal behaviour, or behaviour impacting on other centre users may result in me being asked to leave.* YesI agree to this information being collected to allow Sporting Penistone to meet its insurance and legal requirements and to provide a safe sport environment* YesI agree to this data being held in my online Penistone Leisure Centre account until I cease to be a member. I know it can be accessed by gym instructors, and admin staff while managing my account. YesIf I am under 25 I will bring some ID that shows my date of birth* YesGym users aged 12-15I agree to only use the cardio room, not the main gym* YesI agree to only attend the gym, including my induction, with a parent / guardian who is aged 18+* YesParent / Guardian (of 12-17yr old)Parent / Guardian name* First Last Parent / Guardian email Parent / Guardian phone no*For emergency contactAs parent / guardian of the child, I have checked that the above questions have been answered correctly to the best of my knowledge. I agree to all the conditions above and give permission for my child to attend the gym.*I have read the gym policy: https://www.penistoneleisurecentre.org.uk/gym-policy/ YesΔ
