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STRONG Nation Group Fitness Classes

STRONG Nation Group Fitness Classes Registration

Participant Information

Participant Name(Required)
Participant Address(Required)
Participant's Date of Birth(Required)

Parent/Guardian Information - if participant under 18 years old

Parent/Guardian Address
Emergency Contact Name - All Participants to Complete(Required)

Par-Q and Medical History

Physical Activity Readiness Questionnaire
1. Has a doctor ever said you/your child has a heart condition and that you/he/she should only perform physical activity recommended by a doctor?
2. Do you/your child feel pain in your/his/her chest when performing physical activity?
3. In the past month, have you /your child had chest pain when NOT performing physical activity?
4. Do you/your child lose your/his/her balance because of dizziness or do you/he/she ever lose consciousness?
5. Do you /your child have a bone or joint problem that could be made worse by a change in your/his/her physical activity?
6. Is your/your child’s doctor currently prescribing any medication for blood pressure or a heart condition?
7. Do you know of any reason why you/your child should not engage in physical activity?

Waiver

I understand that I am purchasing group training sessions for myself or my child and must read, agree to and sign this agreement where I assume the risks for participation, waive of liability, and agree to the Total Strength Fitness policies and procedures.

I understand that the program is voluntary and that a Certified Personal Trainer will lead Strong Nation (by Zumba) fitness classes, which includes high intensity exercises where modifications are demonstrated and encouraged. I represent that I will complete the PAR-Q and any other health history form accurately and completely on behalf of myself or my child including disclosure of any exercise limitations I am aware of or have been informed of by my/my child’s doctor. During the program if my/my child’s condition or medical limitations should change, I will notify the Trainer. I understand that it is recommended that i/my child have a yearly physical or more frequent physical examination and consultation with my/his/her physician as to physical activity and diet so I am aware of what is appropriate for me/my child. I acknowledge that I/my child either have had a physical exam and has been given a physician’s permission to participate or I have decided to allow myself/my child to participate without approval of a physician.

I understand that a Trainer will review my my child’s PAR-Q and any other health history form but that a Trainer is not a physician and cannot replace the advice and expertise of a qualified physician.

I understand that I have the complete right to stop or decrease my/my child’s exercise at any time during a session and that it is my/ my child’s obligation to inform the Trainer of any symptoms such as fatigue, shortness of breath or chest discomfort.

I realize that participation in an exercise training program includes but is not limited to exercising, use of exercise equipment and strenuous exertion (such as strength training or high intensity aerobic activity) which will increase heart rate and body temperature.

I understand that exercise involves certain risks, including but not limited to, serious neck and spinal injuries resulting in complete or partial paralysis, heart attack, stroke or even death. Also, injuries could occur to bones, joints or muscles. Slips, falls, and unintended loss of balance could result in muscular, neurological, orthopedic or other bodily injury. I understand that part of the risk involved in undertaking any activity or program is relative to my/my child’s own state of fitness or health (physical, mental, or emotional) and to the awareness, care and skill which I/my child conducts himself/herself in that activity or program. I understand that proper form of any exercise (as described and/or demonstrated by Trainer) performed by me/my child is a necessary and essential component of an exercise program.

Knowing the material risks and knowing and reasonably anticipating that other injuries are a possibility, I hereby expressly assume all of the delineated risks of injury, all other possible risk of injury, and even risk of possible death, which could occur by reason of my/my child’s participation.

I do hereby waive, release and forever discharge Total Strength Fitness and the STRONG Nation (by Zumba) fitness program from any and all responsibilities or liability for any present and future injuries or damages resulting or arising from my/my child’s participation in any activities including but not limited to exercise, group training, or use of the equipment used within STRONG Nation (by Zumba) Group Fitness classes. I also understand that STRONG Nation Group Fitness classes may take place in a facility not owned by Total Strength Fitness, and this facility may have its own equipment not used by STRONG Nation. I understand that I/my child will not use any equipment not included in the STRONG Nation Group Fitness classes during the time that I/he/she am/is participating in these group fitness classes.
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Personal Training Policies and Procedures

1. STRONG Nation group fitness classes are purchased upfront and in their entirety.
2. Total Strength Fitness does not offer refunds for unused sessions by client.
3. PAR-Q and Waiver, and Agreement must be completed, signed, and on file prior to the beginning of the first session.
4. Training sessions will begin promptly at the time specified by Total Strength Fitness and end 60 minutes, or other agreed upon amount of time, from that specified time.
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Parent/Guardian Agreement - if Participant is under 18 years old

I declare that I have read, understand and agree to the contents of this Total Athlete Training Agreement in its entirety. I understand that the Assumption of Risk, Waiver of Liability, and Total Athlete Training Policies and Procedures are intended to be as broad and inclusive as permitted by the State of Minnesota and agree that if any portion is held invalid, the remainder will continue in full force and effect.
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Payment

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Contact Me

Colleen Prudhomme
Owner/Certified Personal Trainer

Total Strength Fitness
4020 Woodhill Court
Rockford, MN 55373

(763)438-8048

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About Colleen

Colleen is an accomplished leader, business owner, speaker, author and athlete. Her passion is to help others discover ways to live their lives through their passion and purpose. She offers practical, effective tools to help her clients and audiences achieve Total Strength Fitness!

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