Physical Activity Readiness Questionnaire (PAR-Q)

PAR-Q is designed to help you help yourself.  Many health benefits are associated with regular exercise, and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life.

For most people, physical activity should not pose any problems or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.

Common sense is your best guide in answering these few questions.  Please read the carefully and check YES or NO opposite the question if it applies to you.  If yes, please explain

Uneven, irregular, or skipped heart beats including a racing or fluttering heart

Please Explain ALL “YES” answers:

Please Note:  If you contract a communicable disease, it is your responsibility to inform Michael Ball of this condition and your work-out may be suspended until this condition is cured or in a state of remission.

PLEASE READ ENTIRE CONTRACT BELOW

Personal Trainer Michael --- Personal Training/Client Agreement --- Agreement: Client agrees to start a diet and exercise/rehabilitation program and understands that successful completion of this program obligates client to maintain a well balanced diet that never goes below 1,200 calories for women or 1,400 for men per day. Client further agrees that the following terms and conditions shall apply to client’s participation in the program. 1. Client represents that he/she is in physically condition to start exercise/rehabilitation and is aware of no physical reason which would prohibit him/her from safely participating in a diet and exercise program. 2. Client understands that Michael Ball is not a medical practitioner. Client agrees or put him or her at risk from such participation to discuss any questions or concerns of health or ability to safely comply with the program, with client’s own physician and to report the results of such discussions, as well as the concerns, to Michael Ball immediately. 3. Client agrees that all diet, exercise, and uses of facilities, are undertaken by client, at the sole risk of client, and that no claims for any injuries or damages whatsoever to person or property of client arising out of the client’s participation in Michael Ball’s Exercise/Rehabilitation Program shall be made. 4. Client agrees to inform Michael Ball immediately when running late (see tardiness policy below) or if client needs to cancel and reschedule (see cancellation policy below). 5. Client understands that a work out session can vary from 30 to 60 minutes depending on the type of work out. 6. Client agrees that sessions on national holidays will count as 2 sessions! 7. Client agrees to pay $25.00 returned check fee in case of a bounced check payment and $25.00 for every week payment is late. Liability Waiver: I, the client, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in physical activity with Personal Trainer Michael Ball and Body USA. Having such knowledge, I hereby release Michael Ball and Body USA, his representatives, agents, and successors from liability for accidental injury, illness or death which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program. I agree to disclose any physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in said fitness program. I also understand that personal fitness training may require physical contact from the personal trainer to prevent injuries and therefore I will not sue Michael Ball for sexual harassment in such case. I fully understand the dangers of participating in physical activity that could result from complications which include but are not limited to health problems. I understand that I may incur complications as a result of my participation in this activity. I hereby release and forever discharge Michael Ball from any liability now or in the future arising from my participation in this activity. In consideration of my participation, I for myself, and my heirs and assigns, hereby release and forever discharge Michael Ball from any claims, demands, and causes of action arising from my participation in this activity in past, present, and future. Tardiness Policy: Please be at the gym at least five (5) minutes before your appointment time. If you are late the session must still finish on time and therefore your work out time may be cut short. Cancellation Policy: Personal Trainer Michael operates on a scheduled appointment basis for all Private Training Sessions and thus, requires that Client provides 12 hours’ notice when canceling an appointment. No charge will be levied should Client cancel with MORE than 12 hours’ notice given. Should Client cancel a session with LESS than 12 hours’ prior notice; Client will be charged in full for that session. Client understands that Personal Trainer Michael recommends that all cancelled sessions be rescheduled to ensure consistency and fitness progress. As your personal trainer, if I am unable to keep an appointment for any reason and unable to give you a 12 hours notice, you will receive a free personal-training session. Refund Policy: Client agrees that all sales are final. No refunds. Refunds of pre-paid sessions are available for only the following two reasons: 1. Client notifies Michael Ball that client is canceling this agreement, prior to midnight of the first business day following the first personally supervised exercise session. 2. Client will be granted a pro-rata refund for sessions and services not performed effective within 72 hours after client has provided Michael Ball with a medical doctor’s written statement that client should not continue the sessions and services due to medical reason(s). I, the client, acknowledge that I have read, understand, and agree to the foregoing service agreement and have received copy here of this agreement shall constitute the entire agreement between Michael Ball and myself, and no amendments shall be made, except in writing and signed by both parties. I also affirm I am over 18 years of age. If any part of this agreement is found to be unenforceable that portion will not invalidate the rest of this agreement. Appendix contract: Minimum amount of pre-paid sessions: All sessions must be pre-paid. I will not accept “pay-per-session” Minimum number of pre-paid sessions is 6. Expiration dates for pre-paid sessions: The number of pre-paid sessions will expire in the equal number of weeks. Example: 36 sessions will expire in 36 weeks from purchase. Cancellation Policy: Personal Trainer Michael operates on a scheduled appointment basis for all Private Training Sessions and thus, requires that Client provides 12 hours’ notice when canceling an appointment. No charge will be levied should Client cancel with MORE than 12 hours’ notice given. Should Client cancel a session with LESS than 12 hours’ prior notice; Client will be charged in full for that session. Client understands that Personal Trainer Michael recommends that all cancelled sessions be rescheduled to ensure consistency and fitness progress. As your personal trainer, if I am unable to keep an appointment for any reason and unable to give you a 12 hours notice, you will receive a free personal-training session. Tardiness Policy: Please be at the gym at least five (5) minutes before your appointment time. If you are late the session must still finish on time and therefore your work out time may be cut short. I verify that I understand and will abide by these policies Waiver of Liability, Indemnity Agreement, and Assumption of Risk Waiver: In consideration of permission to use, today and on all future dates the property, facilities, and services of Body USA and/or Michael Ball or any other location I, on my heirs, personal representatives, or assigns, do hereby release, waive, discharge, and covenant not to sue, Body USA or Michael Ball, its directors, officers, employees, volunteers, independent contractors, and agents from liability from any and all claims arising from the ordinary negligence of Body USA and/or Michael Ball or any of the aforementioned parties. This agreement applies to 1) personal injury (including death) from accidents or illnesses arising from the participation in Body USA and/or Michael Ball’s activities including, but not limited to, organized activities, classes, observation, and individual use of facilities, premises, or equipment; and to 2) any and all claims resulting from the damage to, loss of, or theft of property. Indemnification and Hold Harmless: I agree to HOLD HARMLESS AND INDEMNIFY Body USA and/or Michael Ball from all claims resulting from negligence and to reimburse them for any expenses incurred by Body USA and/or Michael Ball in investigating and defending a claim or suit if my claim is withdrawn, or to the extent a court or arbitration determines that Body USA and/or Michael Ball is not responsible for the injury or loss. Assumption of Risks: Physically activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. Body USA and/or Michael Ball or any other location has facilities for and provides for activities such as weight lifting, walking, jogging and running, aerobic activities, and stretching. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of direction, and others involve sustained physical activity, which places stress on the cardiovascular system. The specific risks vary from one activity to another, but in each activity the risks range from 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as loss of sight, joint or back injuries, concussions, and heart attacks to 3) catastrophic injuries including paralysis and death. I have read the previous paragraphs and I know the nature of the activities at Body USA and/or Michael Ball or any other location, I understand the demands of those activities relative to my physical condition and skill level, and I appreciate the types of injuries, which may occur as a result of activities made possible at Body USA and/or Michael Ball or any other location. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. Severability and Venue: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Likewise, I agree that if legal action is brought, it must be brought in California. Acknowledgement of Understanding: I have read this assumption of risk and full understand its terms. I acknowledge that I am signing freely and voluntarily and intend my signature to signify a complete assumption of the inherent risks of participating or observing recreational activities at Body USA and/or Michael Ball or any other location to the greatest extent allowed by law in the State of California. I read and understand English. If any part of this agreement is found to be unenforceable that portion will not invalidate the rest of this agreement.

ELECTRONIC SIGNATURE I HAVE READ AND AGREE TO THE ENTIRE CONTRACT. PLEASE ACCEPT THIS AS MY ELECTRONIC SIGNATURE

(Please accept the above as an electronic signature)