Velocity PARQ and Terms

Please only fill out this form if you have completed the Direct Debit form.

You will be required to upload/take a photo of yourself and make your sign up payment (£15)as well

First name

Email Address

Last name

Date of Birth

Phone

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

Is your doctor currently prescribing medication for your blood pressure or heart condition? *

Yes

Do you know of any other reason why you should not take part in physical activity? *

Yes

If YES, please comment:

I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.

Having answered YES to one of the questions above, I have sought medical advice and my GP has agreed that I may exercise

Please upload a picture of your face for your membership.

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I agree to the Velocity Gym rules, failure to adhere to these rules may revoke my membership, without financial compensation.View terms of use

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01263 732180

PARQ Form

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