I declare to the best of my knowledge that I know of no reason why I should not participate in activities provided on the

premises. I warrant that I am in a good state of health, fitness and physical condition and that there is no medical reason

whatsoever that could be regarded as a restriction upon or an impediment to my participation. I understand that I enter the

exercise programmes at my own risk and undertake that I will not take legal recourse for damages to myself which may arise

to my participation.

Details on this form are strictly confidential and used by “Omelette Menu” solely for the purpose of health screening and

program prescription. Access to this information by third party, will not occur without a client’s written consent.

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

PAR Q FORM