PARQ

PAR-Q

PERSONAL DETAILS

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MEMBER AGREEMENT

  1. PARTICIPATION

I have chosen to participate in the services offered by GRACIE BARRA LEAMINGTON SPA. Services include but are not limited to, the use of all fitness equipment, training equipment, coaching services, group classes, personal training, group personal training, performance services, athlete development programme, fitness programme, either by myself or with the presence of a coach. I understand that: 1.1
For the duration of my membership I will be doing a wide range of training techniques; 
1.2 I will always use the equipment in GRACIE BARRA LEAMINGTON SPA in the correct way to avoid any potential injury or harm to myself or any other members

  1. ASSUMPTION OF INHERENT RISK

2.1 I acknowledge that the physical training techniques that I will partake in at GRACIE BARRA LEAMINGTON SPA can involve high levels of physical contact/exercise that carries with it inherent risks of physical injury. I also acknowledge some classes are highly strenuous (including aerobic exercise, fitness, resistance exercise, stretching, boxing, are risks and dangers generally in taking part in such activities.

2.2 I understand that it is my responsibility to consult with my general medical practitioner (GP) prior to participating in any physical activity at GRACIE BARRA LEAMINGTON SPA to ensure I am fit and well enough to take part and that my participation will not pose any unusual or serious risks to my health or wellbeing. 2.3 I understand that it’s my responsibility to inform the trainers if I feel unsafe at any point during
training at GRACIE BARRA LEAMINGTON SPA and would like to stop.

  1. LIMITATION OF LIABILITY

3.1 Subject to clause 3.2 I agree that I will not make any claim against or otherwise hold liable in any way GRACIE BARRA LEAMINGTON SPA, Any other member and/or any other person associated with GRACIE BARRA LEAMINGTON SPA (including, but not limited to, any trainers, coaches or providers of facilities or the gym itself) for any matter arising out of or in connection with my participants in the services offered at GRACIE BARRA LEAMINGTON SPA, including but not limited to: 3.1.1 personal injury (including death) which may include but not limited to injury caused during any of the training services offered at GRACIE BARRA LEAMINGTON SPA, the gyms premises and travelling to and from any occasion associated with the gym 3.1.2 damages to, loss of, or theft of my property during the use of GRACIE BARRA LEAMINGTON SPA 3.2 Nothing
in this agreement shall limit or exclude either GRACIE BARRA LEAMINGTON SPA or any associated parties’ liability for death or personal injury resulting from its negligence or any other liability, which cannot be lawfully limited or excluded.

  1. INDEMNITY

Subject to clause 3.2 I hereby agree to reimburse GRACIE BARRA LEAMINGTON SPA and any other person, company or organization associated with GRACIE BARRA LEAMINGTON SPA in respect of:
4.1 Any and all claims made by any party associated with me arising from injury or loss due to my participation in the
services provided by GRACIE BARRA LEAMINGTON SPA; and/or 4.2 Any and all claims by co-participants, trainers, and
others arising from my conduct in the course of my participation as a member at GRACIE BARRA LEAMINGTON SPA

  1. AGREEMENT

5.1 I confirm that I am in good health and in proper physical condition to safely participate in the services provided by GRACIE BARRA LEAMINGTON SPA, and that I have no known physical or mental conditions that would affect my ability to safely participate in the services offered at GRACIE BARRA LEAMINGTON SPA
5.2 I acknowledge that GRACIE BARRA LEAMINGTON SPA recommend and encourage that I obtain medical clearance from my GP prior to participating and I have not been advised or cautioned against participating in any of the services offered by GRACIE BARRA LEAMINGTON SPA by any medical practitioner.
5.3 I agree that I will immediately notify GRACIE BARRA LEAMINGTON SPA of any changes to my physical or mental condition that may be of risk to me or others.
5.4 In the event of injury to me that renders me unconscious or incapable of making a medical decision, I authorise appropriate GRACIE BARRA LEAMINGTON
SPA personal and emergency medical personnel at the gym to make emergency medical decisions on my behalf (including but not limited to CPR and the use of Automated External Defibrillator)
5.5. I agree not to consume alcohol or any non-prescription drugs during the use of any services offered by GRACIE BARRA LEAMINGTON SPA

  1. PARTICIPATION

I acknowledge and agree personnel from GRACIE BARRA LEAMINGTON SPA or any associated parties have the right to stop me participating in any of 6.2 I am under the influence of alcohol or non-prescription drugs
during my participation.
6.3 I am behaving in an
inappropriate manner towards staff and/or other
participants.
6.4 I am behaving in a manner which may bring GRACIE BARRA LEAMINGTON SPA into disrepute or damage its reputation.

  1. DATA PROTECTION

7.1 I understand that GRACIE BARRA LEAMINGTON SPA will process my personal data for legitimate business purposes in order to organise the services provided by GRACIE BARRA LEAMINGTON SPA and that they will, where necessary, pass on my personal information to any third parties to ensure that I receive all relevant information in relation to GRACIE BARRA LEAMINGTON SPA and the services that are provided by GRACIE BARRA LEAMINGTON SPA. I appreciate that my data will be handled in accordance with GRACIE BARRA LEAMINGTON SPA privacy notice
and, in particular, I understand that GRACIE BARRA LEAMINGTON SPA may use photographs of me for promotional purposes.
7.2 I consent to GRACIE BARRA LEAMINGTON SPA processing special category data (as defined in the Data Protection Act 2018) supplied by me to them including, but not limited, to the following: information about my physical or mental health or condition in order to monitor or decide whether I am able to participate in the training and services provided by GRACIE BARRA LEAMINGTON SPA; and in order to comply with legal requirements and obligations to third parties. I acknowledge that I may withdraw my consent to the use of special category data at any time but that, if I do
so, I will not be allowed to further participate in the services offered by GRACIE BARRA LEAMINGTON SPA The services provided by GRACIE BARRA LEAMINGTON SPA if:
6.1 I have not obeyed any rules or regulations or my behaviour endangers the safety of myself, others and property.

ACKNOWLEDGEMENT OF UNDERSTANDING

I have read this Agreement and fully understand its terms. I understand that I am limited my rights, including my rights to sue. I further acknowledge that I am signing this Agreement freely and voluntarily. In signing this Agreement, I acknowledge that I agree and accept the terms above and I am voluntarily taking part in the services provided at GRACIE BARRA LEAMINGTON SPA and training provided there and am fully aware and appreciate the inherent risks of participation.


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PHYSICAL ACTIVITY READINESS QUESTIONNAIRE (PAR-Q)

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

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

YOU MUST ANSWER ALL QUESTIONS HONESTLY

1. Do you have a bone or joint problem such as arthritis? *
2. To your knowledge, do you have high or low blood pressure? *
3. Do you have Diabetes mellitus or any other metabolic disorder? *
4. Has your doctor ever said that you have raised cholesterol (serum level above 6.2mmol/L)? *
5. Do you have/have you ever suffered a heart condition / is there any history of Coronary Heart Disease in your family? *
6. Have you ever felt pain in your chest when you do physical exercise? *
7. Is your doctor currently prescribing you drugs or medication? *
8. Have you ever suffered from shortness of breath at rest or with mild exercise? *
9. Do you ever feel faint, have spells of dizziness or have ever lost consciousness? *
10. Are you, or is there any possibility that you might be pregnant? *
11. Do you know of any other reason why you should not participate in the services provided by GRACIE BARRA LEAMINGTON SPA COVENTRY? *
12. Do you suffer from epilepsy? *
13. Do you have any blood borne diseases; hepatitis, HIV? *
14. Does the number 12 come after the number 11? *
15. Do you have any skin conditions; i.e. dermatitis? *
16. Do you have any known allergies? *
17. Do you have Asthma? (If YES, give your inhaler labeled with you name to the Coaches before you start training) *

If you have ANSWERED YES to questions in the PAR-Q and not already done so, consult with your doctor by telephone or in person before increasing your physical activity. Inform your doctor of the questions that you answered ‘yes’ to on the PAR-Q or present your PAR-Q copy. After medical evaluation, seek advise from your doctor as to your suitability for the activity you wish to undertake.

If you have answered NO to all questions honestly and accurately, you have reasonable assurance of your present suitability for unrestricted physical activity.

Assumption of Risk

I hereby state that I have read, understood the information above and have answered honestly the questions. I also state that I wish to participate in activities, which include aerobic exercise, resistance exercise, stretching, boxing, boxing sparring and martial arts. I realise that my participation in these activities involve the risk of injury. I hereby confirm that I am voluntarily engaging in exercise, which has been recommended to me.

Use of my Personal Data

By signing this form I consent to GRACIE BARRA LEAMINGTON SPA collecting and storing the personal data that I have provided in this form. I acknowledge that this personal data will be handled in accordance with the privacy policy of GRACIE BARRA LEAMINGTON SPA and that it is necessary for them to have it to ensure that all training run at GRACIE BARRA LEAMINGTON SPA is run safely. I consent to the sharing of this data with all those who are organising training for the services provided at
GRACIE BARRA LEAMINGTON SPA in which I want to take part and anyone who may provide the services for me. I understand that I may withdraw my consent to the use of this data at any time but that, if I do so, I will not be allowed to participate in any of the services provided by GRACIE BARRA LEAMINGTON SPA.

Signing this agreement means you understand the
above, agree to take part in the services provided by GRACIE BARRA LEAMINGTON SPA & are aware of any risks that could occur.

Enter your full name to sign.