Project HB ParQ & Waiver Form
A form to fill in to confirm your are in adequate health and to confirm that you understand the risks involved in physical activity,  before taking part in an exercise class with Carly Wilkinson under the brand Project HB Fitness.

Why collect this data? This form is asking you to accept the risks of physical exercise, meaning my professional indemnity and public liability insurance is valid, which I need in order to teach you safely and legally. I also gather a little data on your current health and fitness levels, which helps me ensure I'm the right instructor for you. The contents of this form protects us both.
 
What do I do with your data? I store form securely for 6 years from the day you last attended an exercise session with me, upon which point your data will be permanently deleted. If you want me to delete your data before this cut off time, please just email me at projecthb@live.co.uk requesting this, and I will delete all data I have stored about you, immediately.

Please note: You may need to complete this form again, if you request I delete your data, and then want to attend another class.  
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Provide your full name *
Provide your email address *
Provide your telephone number *
Provide the full name, relationship and contact number of your emergency contact *
Would you like to be added to the Project HB mailing list?
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *
Required
2. Do you feel pain in your chest when you do physical activity? *
Required
3. In the past month, have you had chest pain when you were not doing physical activity? *
Required
4. Do you lose your balance because of dizziness or do you ever lose consciousness? *
Required
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? *
Required
6. Is your doctor currently prescribing drugs for your blood pressure or heart condition? *
Required
7. Are you in the first trimester of pregnancy or do you suspect that you might be pregnant? *
Required
8. Do you know of any other reason why you should not do physical activity? *
Required
Taking part in physical exercise
IF YOU ANSWERED YES TO ONE OF MORE QUESTIONS ABOVE, talk with your doctor BEFORE you take part in a fitness session. Tell your doctor about which questions you answered YES.

IF YOU ANSWERED NO, HONESTLY, TO ANY QUESTIONS ABOVE, it's still strongly recommended you consult with your doctor before beginning any exercise program, and are able to provide medical approval to exercise, if requested.

You should understand that when participating in any exercise, there is the possibility of physical injury to yourself. By engaging in these sessions, you agree that you do so at your own risk, are voluntarily participating in these activities, and understand that you can stop at any time if you feel discomfort or pain.

Please Note:
If your health changes so that you answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan. If in doubt after completing this questionnaire, consult your doctor prior to physical activity.

TYPE YOUR NAME to CONFIRM YOU HAVE UNDERSTOOD THE QUESTIONS ABOVE: I, the undersigned have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction. *
TYPE YOUR NAME to GIVE CONSENT TO PARTICIPATE: Type your name to confirm the following: I, the undersigned understand the exercise session that I will perform and the associated risks and discomforts. Knowing these risks and discomforts, I understand that I am free to cease exercising at any point during the session. I consent to participate in this exercise session. *
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