Personal Trainer

Personalized Services Consultation Form

Please check the service you are interested in

Personal Information

Are you a YWCA Health + Fitness member?

Your Goals

Cancellation Policy

1. It is your responsibility to contact your personal trainer directly to cancel the appointment and reschedule.

2. 24 hours’ notice is required for cancellation of a session. You may be charged for your missed appointment.

**Please Note: All personalized services packages and gift certificates purchased must be completed within one year of the purchase date.

Medical Screening Form

Please read carefully and check YES or NO.

1) Has your doctor ever said that you have a heart condition OR high blood pressure?
2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
3) Do you lose your balance because of dizziness or do you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise)
4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
5) Are you currently taking prescribed medications for a chronic medical condition?
6) 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? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.
7) Has your doctor ever said you should only do medically supervised physical activity?
8) Are you used to doing vigorous exercise (e.g. 20 minutes) 2 - 3 times per week?

If you answered YES to one or more of the questions about your medical condition, you should seek further information before becoming more physically active or engaging in a fitness appraisal and complete a ParMedx.

 

Release Form

We advise you that if you are currently taking medication, have any physical ailment or are otherwise not in a physical condition suitable for the activity, it could be injurious to you. You should seek medical advice regarding these matters before participating in these programs. THIS DOCUMENT IS A RELEASE OF CLAIMS AND BY SIGNING IT YOU:

1.  Acknowledge that when performing exercise routines or engaging in similarly strenuous activity, you may suffer injury.

2.  Represent to YWCA Metro Vancouver that you are in good health and physical condition and are not disabled, taking medication or suffering from a condition that would prevent you from engaging in such activities or make it potentially dangerous or harmful for you to engage in such activities.  Any significant changes in health will be disclosed to YWCA Metro Vancouver.

3.  Acknowledge that YWCA Metro Vancouver may retain a copy of this form for records. 

4.  ASSUME THE RISK OF AND HOLD YWCA METRO VANCOUVER HARMLESS FROM ANY LIABILITY FOR ANY PHYSICAL OR OTHER INJURY OR HARM SUFFERED BY YOU DURING OR AS A CONSEQUENCE OF PARTICIPATING IN SUCH PROGRAMS OR PERFORMING SUCH EXERCISE ROUTINES OR ENGAGING IN SUCH OTHER STRENUOUS PHYSICAL ACTIVITY, AND AGREE THAT YWCA METRO VANCOUVER SHALL NOT HAVE ANY LIABILITY OR RESPONSIBILITY FOR ANY SUCH INJURY OR HARM.

I HAVE CAREFULLY READ, UNDERSTAND, AND AS AN INDUCEMENT TO YWCA METRO VANCOUVER TO ALLOW ME TO PARTICIPATE IN THE PROGRAMS, AGREE TO THE FOREGOING.