Client Form - Under 18s

The form below is compulsory for all clients of Emily Ingham Fitness Ltd. The top section of the form is to be completed by all clients. Further down the form, it is split into 2 sub-forms: Personal Training and Fitness Together Bootcamp. Please complete all sections that are relevant to your training. Must be completed by a parent/carer over the age of 18.

First name

Last name

Birthday

Day

Month

Year

Gender

Male

Female

Prefer not to

Email

Phone

Address

Emergency Contact - Name and Number

Yes, subscribe me to your newsletter.

PAR-Q Form

Please tick any of the following for which your child has been diagnosed or treated by a health professional.

1) Has your doctor ever said that you have a heart condition or high blood pressure?

Yes

No

2) Do you feel pain in your chest at rest, during your daily activities or when you do physical activity?

Yes

No

3) Do you lose balance because of dizziness or have you lost consciousness in the last 12 months?

Yes

No

4) Have you been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?

Yes

No

5) Are you currently taking any prescribed medications for a chronic medical condition?

Yes

No

6) Do you have any (or have had in the past) a bone, joint or soft tissue (muscle, ligament or tendon) problem that could be made worse by becoming more physically active?

7) Has your doctor ever said that you should only do medically supervised physical activity?

Yes

No

If you answered yes to any above questions, please give more details about conditions here.

If you answered yes to taking prescribed medication, please give more details here.

If there is anything not covered above, please give more information here.

I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that Emily Ingham Fitness Ltd may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

Signature

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Based on the information you have given, an exercise programme will be designed for your child. This will involve activities to progressively challenge your child's cardiorespiratory and musculoskeletal systems (heart, lungs, muscles and joints). Your child may feel tired during and following the exercise sessions, and occasionally experience some soreness, but this is not unusual and your child will be monitored closely. Please consult your trainer if you have any concerns.

Signature

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I give consent for pictures to be takenof my child to be used online and on social media. (Can be opted out at any time during a session)

Signature

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Personal Training Form

Please ask the following questions to your child and write their answers below.

What would you like to achieve from the personal training sessions?

Please describe your training history in the last 2 years. Please include: the type of training (ie running, weight training, circuits), how often you trained, the intensity of the sessions and the length of the sessions.

Do you have any exercise likes or dislikes?

Client and Trainer Agreement

The client:

• I agree to give a minimum of 24 hours notice to reschedule my sessions. I understand that if I do not give 24 hours notice, the session can not be rearranged.

Signature

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Bootcamp Form

Please complete the questions below if you are a Fitness Together Bootcamp client.

What is your reason for participating in the sessions?

Is there any reason your training may be affected? (ie holidays, children etc)

Have you attended a circuit training session before?

Yes

No