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Fitness Class Registration Form

Name: Required
Your email: Required
Address 2:
Postal Code:
Daytime Telephone:
Evening Telephone:

Please Indicate which session you would like to register for.( yes)

Session 1:
Session 2:
Session 3:
Will be dropping in:
Do you need child-care?
If you need child-care, indicate the age of your child(ren):

Informed Consent

Download and sign the Informed Consent Form. This form must be completed prior to participating in the class Click here to download. (PDF file, 99kb)Please bring signed form to class.


For most people physical activity should not pose any problem 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 them carefully and check the yes or no opposite the question if it applies to you.
1. Has your doctor ever said that you have a heart condition and recommended only medically approved physically activity?
2. Do you have chest pain brought on by physical activity?
3. Have you developed chest pain at rest in the past month?
4. Do you lose consciousness or lose your balance as a result of dizziness?
5. Do you have a bone or joint problem that could be aggravated by physical activity?
6. Is your doctor currently prescribing medication for your blood pressure or heart condition? (e.g.: diuretics or water pills)
7. Are you aware, through your own experience or a doctor's advice, of any other reason against your exercising without medical approval?

If you answered YES to one or more questions...

If you have not recently done so, consult with your personal physician by telephone or in person before increasing your physical activity and/or taking a fitness test.

If you answered NO to all questions...

If you answered PAR-Q accurately, you have reasonable assurance of your present suitability for an exercise test.


1. This questionnaire applies only to those 15 to 69 years of age.
2. If you have a temporary illness, such as fever, or are not feeling well at this time, you may wish to postpone the proposed activity.
3. If you are pregnant, you are advised to consult with your physician before exercising.
4. If there are any changes in your status relative to the above questions, please bring this information to the immediate attention of your fitness professional.
Source: Derived from 'Physical Activity Readiness Questionnaire, British Columbia Ministry of Health Department of National Health and Welfare, Canada, revised 1992.
Please be sure all areas are completed before pressing 'Submit'. Incomplete forms will produce an error and entries will be lost. Hint: Answers can be typed in a word processing program or notepad first, then pasted into the form.

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The information contained within is for educational purposes. It is here to help you made informed decisions about your fitness and health. It is not medical advice and is not intended to replace the advice or attention of health-care professionals. Please consult your doctor before beginning or making changes to your diet, exercise program, for diagnosis and treatment of illness and injuries, and for advice regarding medications and supplements.

In no way will Active Image or any persons associated with Active Image be held responsible for any injuries or problems that may occur due to the use of this website or the advice contained within. Active Image will not be held responsible for the conduct of any companies and websites recommended within this site.

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