Personal Training Packet

Transcription

1 Date: / / Personal Training Packet Name: Phone: Address: City, State, Zip: Affiliation: Date of Birth: Emergency Contact: Emergency Contact Relationship: Emergency Contact Phone: Please indicate which package you purchased: Weight-Room Orientation Personal Fitness Assessment Design Me a Workout Personal Training Sessions Buddy Training Sessions Small Group Training Sessions 1. How would you classify yourself in terms of exercise experience? BEGINNER INTERMEDIATE ADVANCED 2. Please describe your current and/or previous exercise experience? 3. Please list 2 health and fitness goals that you would like to focus on during your session(s): 4. Do you prefer working with a (please circle): MALE FEMALE NO PREFERENCE 5. Do you have a specific trainer in mind? (please circle): YES NO

2 Please indicate specific times in which you are available on the following days: Example: Morning Afternoon Evening Monday 7:00am 9:30am 12:00pm 1:00pm 4:00pm 8:00pm Monday Tuesday Wednesday Thursday Friday Saturday Sunday Morning Afternoon Evening Do you now, or have you had in the past: YES NO History of heart problems, chest pain or stroke. Increased blood pressure. Any chronic illness or condition. Difficulty with physical exercise. Recent surgery (last 12 months). Pregnancy (now or within last 3 months). History of breathing or lung problems Muscle, joint or back disorder, or any previous injury still affecting you. Diabetes or thyroid condition Cigarette smoking habit. Obesity (waist girth >40 men, >35 women). Lead a sedentary lifestyle. Increased blood cholesterol History of high blood pressure, heart disease or diabetes in immediate family Hernia, or any condition that may be aggravated by lifting weights Please explain all Yes answers below: Are you currently taking any over the counter or prescription medications or drugs? If so, please list:

3 I UNDERSTAND THE RISKS INVOLVED IN THE USE OF WEIGHT TRAINING EQUIPMENT. I ASSUME THE RISKS, REALIZING THAT I AM SUBJECT TO INJURY FROM THIS TYPE OF ACTIVITY, AND UNDERSTAND THAT NO FORM OF PREPLANNING CAN REMOVE ALL THE DANGER TO WHICH I AM EXPOSING MYSELF. THE PARTIES TO THIS CONTRACT AGREE THAT THE STATE OF ARIZONA, THE ARIZONA BOARD OF REGENTS, AND NAU SHALL BE INDEMNIFIED AND HELD HARMLESS BY THE PARTICIPANT FOR ITS VICARIOUS LIABILITY AS A RESULT OF ENTERING INTO THIS CONTRACT. HOWEVER, THE PARTIES FURTHER AGREE THAT THE STATE OF ARIZONA, THE ARIZONA BOARD OF REGENTS, AND NAU SHALL BE HELD RESPONSIBLE FOR ITS OWN NEGLIGENCE. EACH PARTY TO THIS CONTRACT IS RESPONSIBLE FOR ITS OWN NEGLIGENCE. IN CONSIDERATION OF THE PERMISSION GRANTED TO ME BY THE NAU RECREATION CENTER, THE UNDERSIGNED, FOR HIM/HER (THE PARTICIPANT), HIS/HER PARENTS, CHILDREN, HEIRS, ESTATE AND ASSIGNS, RELEASES AND DISCHARGES NAU, THE ARIZONA BOARD OF REGENTS, THE STATE OF ARIZONA, AND ITS REPRESENTATIVES OF AND FROM ALL LIABILITY, CLAIMS, DEMANDS, ACTIONS AND CAUSES OF ACTION OF ANY SORT FOR LOSS, DAMAGE OF INJURY SUSTAINED BY THE PARTICIPANT AND/OR HIS/HER PROPERTY DURING THE USE OF THE NAU RECREATION FACILITY. Name Signature Date CANCELLATION POLICY: TO FACILITATE THE BEST SERVICES FOR ALL OF OUR CLIENTS, WE HAVE INSTITUTED A CANCELLATION POLICY. CANCELLATIONS MUST BE MADE AT LEAST 12 HOURS PRIOR TO YOUR SESSION. IF YOU FAIL TO CANCEL, YOUR MISSED SESSION WILL COUNT AS ONE OF YOUR PAID SESSIONS. IF YOU WILL BE LATE FOR YOUR SESSION, PLEASE CONTACT OUR OFFICE OR YOUR TRAINER PRIOR; IF YOU ARE 15-MINUTES LATE, WITHOUT PRIOR NOTICE, LOSS OF SESSION WILL OCCUR. FOR ANY PROGRAM CANCELED BY THE DEPARTMENT, PARTICIPANTS WILL RECEIVE A FULL REFUND OF ALL REGISTRATION FEES PAID THUS FAR. ALL OTHER REFUND REQUESTS MUST BE SUBMITTED IN WRITING TO THE BUSINESS OFFICE. NO REFUNDS WILL BE ISSUED FOR PURCHASES/PROGRAMS UNDER $ ALL OTHER APPROVED REFUNDS WILL INCUR A 20% PROCESSING FEE. CREDITS ARE AVAILABLE, IN LIEU OF A REFUND. CREDITS CAN ONLY BE APPLIED TO OTHER CAMPUS RECREATION SERVICES PROGRAMS AND PURCHASES.

4 EXPIRATION POLICY: IN ORDER TO EFFICIENTLY AND EFFECTIVELY TRAIN YOU, WE MUST COMPLETE YOUR TRAINING SESSIONS WITHIN A DESIGNATED TIME FRAME. Assessment: 4 weeks 3 sessions: 3 weeks 6 sessions: 6 weeks 12 sessions: 12 weeks 18 sessions: 18 weeks 24 sessions: 24 weeks The Physical Activity Readiness Questionnaire PAR Q PAR Q & YOU A Questionnaire for People Age 15 to 69 Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is safe for most people. However, some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common Sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: Check YES or No: YES NO 1. Has your doctor ever said that you have a heart condition and that you should do physical activity recommended by a doctor? 2. Do you feel pain in your chest when you do physical activity? 3. In the past months, have you had chest pain when you were not doing physical activity? 4. Do you lose your balance because of dizziness or do you ever lose consciousness? 5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? 6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? 7. Do you know of any other reason why you should not do physical activity?

5 IF YOU ANSWERED YES to one or more questions Talk to your doctor by phone or in person BEFORE you start becoming much more physically active. Tell your doctor about the questionnaire and which questions you answered YES, and obtain written clearance prior to exercising. You may be able to do any activity you want-as long as you start slowly and build up gradually. Or you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice. Find out which community programs are safe and helpful to you. IF YOU ANSWERED NO to all questions You can start becoming more physically active begin slowly and build up gradually. This is the safest and easiest way to go. Take part in a fitness appraisal-this is an excellent way to determine your basic fitness so that you can plant the best way for you to live actively. It is also recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active. Stay hydrated and wear appropriate footwear and clothing for the activities you participate in. Delay becoming much more active: If you are not feeling well because of a temporary illness such as a cold or a fever-wait until you feel better. If you are or may be pregnant-talk to your doctor before you start becoming more active. Please note: If your health changes so that you then answer Yes to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan. I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction. Name Signature Date Children under 18: (Guardian Signature Below) Name Signature Date