Instructions

Participation in any training session at Granite Bay Strength & Conditioning (GBSC) requires completing this intake form before attending class. The process takes approximately 4–5 minutes, and a copy of your completed form will be emailed to you for your records.

Overview

Regular physical activity is fun and healthy, and increasingly 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.

Please read the questions carefully and answer each one honestly.

GBSC Intake for Wellhub Members

Personal Information

First Name

Last Name

Age

Cell/Mobile Phone

Emergency Contact Information

Please provide the details of the person we should contact in the event of an emergency during your participation at Granite Bay Strength & Conditioning.

Emergency Contact Name (First & Last)

Emergency Contact Phone

Granite Bay Strength & Conditioning
Waiver and Release — Part 1 of 2

By participating in any training or activities at Granite Bay Strength & Conditioning (“GBSC”), I (“Participant”) acknowledge and agree to the following.

Health Warranty

Participant confirms being in good health and free from any condition that could make exercise unsafe or increase the risk of injury.

Assumption of Risk

Participant understands that fitness activities involve inherent risks, including the possibility of serious injury. Participant voluntarily accepts all risks associated with training at or through GBSC.

Waiver and Release of Liability

Participant releases and holds harmless GBSC from any claim, loss, injury, illness, or damage arising from the use of GBSC services, equipment, or facilities, participation in any GBSC‑related activity, or the use of techniques learned during training, including claims resulting in whole or in part from GBSC’s negligence.

Granite Bay Strength & Conditioning
Waiver and Release — Part 2 of 2

Indemnification

Participant agrees to indemnify and hold harmless GBSC from any third‑party claims related to Participant’s participation in GBSC activities.

Miscellaneous

This Waiver is the full agreement regarding liability and may only be modified in writing by an authorized GBSC representative. If any part is found unenforceable, the remaining terms remain in effect.

Acknowledgment

Participant affirms having read and understood this Waiver and agrees to its terms voluntarily. The Waiver remains in effect indefinitely.

I have read the waiver and I accept.

Physical Activity Readiness Questionnaire (PAR‑Q)

The Physical Activity Readiness Questionnaire (PAR‑Q) is a standardized health‑screening tool used worldwide to help determine whether an individual can safely begin or increase physical activity. The next section includes questions designed to identify any conditions that may require medical guidance before participating in exercise.

The PAR‑Q focuses on key areas such as heart conditions, chest pain, dizziness, joint issues, and medications that may affect exercise tolerance. Its purpose is to ensure participants begin physical activity safely and to identify anyone who may need a doctor’s approval prior to engaging in exercise.

PAR-Q Part 1 of 2

Questions 1 thru 6 of 7

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

Do you feel pain in your chest when you do physical activity?

Yes No

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

Yes No

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

Yes No

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes No

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

Yes No

PAR-Q (Part 2 of 2)

Question 7 of 7

Do you know of any other reason why you should not do physical activity? If YES, provide additional explaination.

Yes No

Wellhub Member Intake Summary

If you answered YES to any PAR-Q questions

Talk to your doctor by phone or in person before you start becoming much more physically active or before you have a fitness appraisal. Inform your doctor about the PAR‑Q and which questions you answered YES.

If you answered NO to all PAR-Q questions

If you answered NO honestly to all PAR‑Q questions, you can be reasonably sure that you can begin becoming more physically active. Start slowly and build up gradually—this is the safest and easiest approach.

Your electronic acceptance below confirms that you have reviewed this summary and understand the guidance provided.

Name

Date :
Time :

I confirm that I have read and accept the statements above.

GBSC Intake for Wellhub Members

Instructions

Overview

GBSC Intake for Wellhub Members

Personal Information

Emergency Contact Information

Granite Bay Strength & ConditioningWaiver and Release — Part 1 of 2

Health Warranty

Assumption of Risk

Waiver and Release of Liability

Granite Bay Strength & ConditioningWaiver and Release — Part 2 of 2

Indemnification

Miscellaneous

Acknowledgment

Physical Activity Readiness Questionnaire (PAR‑Q)

PAR-Q Part 1 of 2

PAR-Q (Part 2 of 2)

Wellhub Member Intake Summary

Granite Bay Strength & Conditioning
Waiver and Release — Part 1 of 2

Granite Bay Strength & Conditioning
Waiver and Release — Part 2 of 2