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The Weightlifting LAB Waiver

To register as an exclusive member with the LAB please fill out the following medical form & new client waiver

First Name

Email Address

Last Name

Date of Birth

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

No

Yes

2. Do you get pain in your chest when you do physical activity? *

No

Yes

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

The weightlifting LAB waiver

To register as an exclusive member with the LAB please fill out the following medical form & new client waiver.

To register, please take the time to fill out the information below.

A questionnaire for people aged 15 – 69 Regular physical activity is fun and healthy, and more people are starting to become more active every day. Being more active is very safe for most people. However some people should check with their doctor before they start becoming much more physically active. If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

First Name

Last Name

Email

Phone

Birthday

Address

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes

No

2. Do you get pain in your chest when you do physical activity?

Yes

No

3. In the past month, have you had chest pain when you were not doing physical activity?

Yes

No

4. Do you lose your balance because of dizziness, or do you ever lose consciousness?

Yes

No

5. Do you have a bone or joint problem (for example, back, knee or hip) that may be made worse by a change in your physical activity?

Yes

No

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

Yes

No

7. Do you know of any other reason that you should not do physical activity?

Yes

No

Your Signature

I agree to the terms & conditions

© 2020 by: The Weightlifting LAB.

Hours of operation

Mon-Thu: 6AM to 9PM

Friday: 6AM to 3PM

Sat: Remote Coaching Available

Sun: Remote Coaching Available

contact us

email: theweightliftinglab@gmail.com

Tel: (613) 864-5769

Address: 2 Bryce Crt, Carleton Place Ontario

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