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Training with Barbell

Personal Training PAR-Q

Let's begin! Kindly complete the PAR-Q form for pre-screening before your training.
Who should fill out this form? All clients enrolling in any of our training programs!

  • Orientation PT Clients

  • In-Person & Online PT Clients

  • Small & Large Group PT Clients

CBalance Client PAR-Q

Personal Activity Readiness Questionnaire

Has your doctor ever said that you have a heart condition OR high blood pressure?
Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? (Medical reasons only)
Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem that could be made worse by becoming more physically active? (Answer NO if it doesn't impede your ability to exercise)
Has your doctor ever said that you should only do medically supervised physical activity?

If you answered NO to all of the questions above, you are cleared for physical activity. You do not need to get Doctor Clearance.


If you answered YES to one or more of the questions above, you may need to get Doctor Clearance before participating in CounterBalance's Personal Training programming.


CONSENT:

Any information that is obtained pertaining to my personal health history, my fitness level and my progress will be treated as privileged and confidential and will not be released or revealed to any person other than select staff aligned with the operations of CounterBalance Conditioning Inc.'s programming, my physician, healthcare practitioner or the program's Supervisor (for record keeping purposes) without my expressed written consent.


I have read and understand the foregoing consent to participation in said program. I am aware that I may discontinue participation in the program at any time that I see fit to do so.


In addition, I agree to the following: assume all risk of injury and all risk of damage to or loss of property arising out of my participation in this programming information; that all PAR-Q and Health information I have provided is accurate and true.


I release, discharge, and waive any and all responsibility of CounterBalance Conditioning & Fitness Inc, Amy J. Gallant, and its employees/affiliates from and against any liability of injury, including death, for damage to or loss of property which may be suffered by the undersigned arising out of, or in any way connected with the participation in this program; and indemnify and hold harmless CounterBalance Conditioning & Fitness Inc, Amy J. Gallant, and its employees/affiliates from and against all liability, claims, demands, actions, loss, and damage arising out of my participation in said Personal Training Programming/Online Coaching/Nutrition Consultation Sessions.


Please sign the PARTICIPANT DECLARATION:

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