Monday, May 21, 2012

Sign Up

General Information
  1. This form will serve as your preliminary registration and health history. Before you begin training you must complete the APT Training Application and return, including parents or legal guardians signature if you are under 18. Download Training Application
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  16. Choose Dates & Time
  18. Health & Medical History
  19. *Please Answer All Questions. If you have been with us before, please update any changes to your health status.
  20. Has a physician ever said you have a heart condition and should only do physical activity recommended by a physician?
  22. When you do physical activity, do you feel pain in your chest?
  24. When you were not doing physical activity, have you had chest pain in the past month?
  26. Are you 55 years of age or older?
  28. Is there a history of heart disease (prior to age 55) in your immediate family?
  31. Do you ever lose consciousness or do you lose your balance because of dizziness?
  33. Do you have high blood pressure?
  35. Is a physician currently prescribing medications for your blood pressure or heart condition?
  37. Do you have a joint or bone problem that may be made worse by a change in your physical activity?
  40. Are you pregnant, or have you been pregnant within the last 3 months?

  42. Have you had major or minor surgery in the last 3 months?
  44. Have you been hospitalized in the last 2 years?
  47. Do you have Type I or Type II diabetes?
  49. Are you allergic to any medication (aspirin, penicillin, sulfa, etc.)?
  52. Do you take any prescribed medications on a permanent or semi-permanent basis?
  55. Have you ever been found to be anemic (low blood count)?
  57. Do you have asthma?
  59. Have you ever injured your back or neck?
  61. Do you have back pain?
  64. Do you have any other physical conditions which cause pain (knee, hip, shoulder, etc.)?
  67. Do you receive regular physical exams from your primary care physician?
  70. Do you have any other health, medical or injury conditions that your trainer should be aware of?
  73. Do you know of any other reason you should not exercise or increase your physical activity?
Approval of Health & Medical History
  1. I have read and understood the above consent agreement and fully completed the questionnaire. I certify that the above statements are true and correct. Any questions I had were answered to my full satisfaction. I understand that a Doctor’s note may be requested. If a note is requested, I should not proceed with this workout until the note is received. I do further hereby consent to the abovementioned risks and am freely and voluntarily participating in this program. Finally, I am freely signing this agreement.
  2. I agree to the above statement
Training Application
  1. Have you completed, signed and agreed to the Traning Application, including the Waiver of Liability, Indemnity Agreement and Assumption of Risk form with Cr8 Health & Fitness/Adrenaline Performance Training?
  3. If no, click here to download the form.
    This form must be complete, including a parents signature if you are under 18, before you can begin training.
Digital Signature
  1. By typing your name into this field, you are hereby providing a digital signature
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