Parq Waiver Form | VFIT NOW

First name

Last name

Email

Mobile

Tick if you suffer from any of the following

Back Problems

Any broken bones

Arthritis

Blood Pressure (indicate High or Low)

Hernia

Hearing problem

Dizziness

Epilepsy

Multiple Sclerosis

Cancer

Any emotional health issues

Joint Problems

Any joint replacements

Asthma/Other Respiratory problems

Heart Conditions (e.g. Angina)

Eye Condition (e.g. cataracts)

Inner Ear problem

Diabetes (indicate Hyper or Hypo)

Osteoporosis

Fibromyalgia

Undergone Surgery recently

On any medications that affects physical ability

If you have ticked any of the above, please provide further details

Are you pregnant?

Yes

No

If yes, please explain what trimester or if Post Natal

Are you currently active?

Yes

No

If yes, what classes / sports do you take part in?

NOTE: Signing this form means that you agree to participating in VFIT Classes online or face to face and understand the nature of the activity and the risks involved, and choose to accept those risks and participate. In no event is VFITnow liable for any direct, indirect, special, incidental, equitable or consequential damages for any services including, without limitation, any lost profits, personal injuries, accidents, misapplication of information, loss of property or otherwise.

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Date

PAR-Q Waiver Form

Health Quesionnaire and Assumption of Risk