WE ARE NOT A GYM

WE’RE A COACHING ENVIRONMENT

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Application Form
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Kaizen Membership Application Form

I understand that the Kaizen Centre is an independent coaching facility and membership can be terminated at any time by either party. Kaizen Centre and it’s coaching team accept no responsibility nor liability in respect of any lost property or injury incurred by clients on or off premises where they may be meeting or training.

I have read and accept all of the above conditions of joining.

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Kaizen Centre will NOT share your details with any third party.


Your email address and telephone number will be used to communicate with you by SMS and/or email. You can opt out of communications at any time.

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Physical Activity Readiness Questionnaire (PAR-Q)
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Physical Activity Readiness Questionnaire (PAR-Q)

PAR-Q is designed to help you help yourself. Many health benefits are associated with regular exercise and the completion of PAR-Q is a sensible first step to take if you are planning to increase the amount of physical activity in your life.

For most people, physical activity should not pose any problems or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them.

Common sense is your best guide in answering these few questions. Please read the carefully and check YES or NO opposite the question if it applies to you. If yes, please explain.

Has your doctor ever said you have heart trouble?pick one!
Do you frequently have pains in your heart and chest?pick one!
Do you often feel fain or have spells of severe dizziness?pick one!
Has a doctor ever said your blood pressure was too high?pick one!
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has been aggravated by exercise, or might be made worse with exercise?pick one!
Are you or have you been pregnant in the last 6 months?pick one!
Do you suffer from any problems of the lower back, i.e., chronic pain, or numbness?pick one!
Are you currently taking any medications?pick one!
Do you currently have a disability or a communicable disease?pick one!

If you answered NO to all questions above, it gives a general indication that you may participate in physical and aerobic fitness activities. The fact that you answered NO to the above questions is no guarantee that you will have a normal response to exercise. If you answered Yes to any of the above questions, then you may need written permission from a physician before participating in physical and aerobic fitness activities.

I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction.

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Health Commitment Statement
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Health Commitment Statement

Your health is your responsibility. The management and coaching team are dedicated to helping you take every opportunity to enjoy the facilities and training that we offer. With this in mind, we have carefully considered what we can reasonably expect of each other.


Our Commitment To You

  1. We will respect your personal decisions and allow you to make your own decisions about what exercise and activities you can carry out. However, we ask you not to exercise beyond what you consider to be your own abilities.
  2. We will make every reasonable effort to make sure that our equipment and facilities are in a safe condition for you to use and enjoy.
  3. We will take all reasonable steps to make sure that our team are qualified to the appropriate standards for each discipline or activity.
  4. If you tell us that you have a disability which puts you at a substantial disadvantage in accessing our equipment and facilities, we will consider what adjustments, if any, are reasonable for us to make.

Your Commitment To Us

  1. You should not exercise beyond your own abilities. If you know or are concerned that you have a medical condition which might interfere with you exercising safely, before you use our equipment and facilities you should get advice from a relevant medical professional and follow that advice.
  2. You should make yourself aware of any rules and instructions, including warning notices. Exercise carries its own risks. You should not carry out any activities which you have been told are not suitable for you.
  3. You should let us know immediately if you feel ill when using our equipment or facilities. Our staff members are not qualified doctors, but there will be a person available who has had first-aid training.
  4. If you have a disability, you must follow any reasonable instructions to allow you to exercise safely. This statement is for guidance only. It is not a legally binding agreement between you and us and does not create any obligations which you or we must meet.

Liability Waiver

Because physical exercise can be strenuous and subject to risk of serious injury, we urge you to obtain a physical examination from a doctor before using any exercise equipment or participating in any exercise activity. You (each client, guest and all participating family members) agree that if you engage in any physical exercise or activity or use any gym amenity on the premises or off premises, you do so entirely at your own risk. Any dietary advice taken is entirely your responsibility and you should consult a physician prior to undergoing any dietary changes. You agree that you are voluntarily participating in these activities and use of these facilities and premises and assume all risks of injury, illness or death. We are also not responsible for any loss of your personal property.This waiver and release of liability includes, without limitation, all injuries which may occur as a result of:

  1. your use of all amenities and equipment in the facility and your participation in any activity, class,
    programme, personal training or
    Instruction;
  2. the sudden and unforeseen malfunctioning of any equipment;
  3. our instruction, training, supervision or dietary advice;
  4. your slipping and/or falling while in the building or on the premises, including adjacent footpaths and parking areas.

You acknowledge that you have carefully read this “waiver and release” and fully understand that it is a release of liability. You expressly agree to release and discharge the centre and all affiliates, employees, agents, representatives, successors or assigns, from any and all claims or causes of action and you agree to voluntarily give up or waive any right that you may otherwise have to bring a legal action against the gym for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of the facility, its agents, and employees. If any portion of this release from liability shall be deemed by a court of competent jurisdiction to be invalid, then the remainder of thisrelease from liability shall remain in full force and effect, and only the offending provision or provisions shall be severed.


Terms & Conditions

  1. All customers must sign the Health Commitment Statement before commencing any exercise programme or activity.
  2. I understand that I use the centre facilities and classes at my own risk and I am ultimately responsible for my own general health and welfare.
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Informed Consent
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Informed Consent
All information will be kept confidential

1. Explanation of the exercise test or programme

You will perform a variety of exercises, tests or activities. The exercise intensity of each will be at a level appropriate to your ability. Your trainer may stop the test or activity at any time because of signs of fatigue or you may stop when you wish because of personal feelings fatigue or discomfort.

2. Risks & Discomforts


There exists a possibility of certain changes occurring during exercise or testing. They include abnormal blood pressure, fainting, disorder of heartbeat and in rare instances heart attack, stroke or death. Every effort will be made to minimise these risks by evaluation of preliminary information relating to your health and fitness and by observations during testing and training. Trained personnel are available to deal with unusual situations should they arise.

3. Responsibilities of the client


Information you possess about your health status or previous experiences of unusual feelings with physical effort may affect the safety and value of your exercise tests and activities. Prompt reporting of feelings of effort during exercise are of great importance. It is your responsibility fully disclose such information when requested.

4. Questions/Injuries

Any questions about the procedures, tests, exercises or activities are encouraged. If you have any concerns or questions, please ask for further explanation.

5. Freedom of Consent


Your permission to perform tests, exercises and activities is voluntary. You are free to deny consent or stop at any point, if you so desire.

I have read this form and I understand the test procedures, exercises and activities that I will perform. I consent to participate.


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Trainer Signature
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