iconic.par(q) & informed consent

Please fill in the Par(q) before undertaking any fitness activity with iconic. This is a pre activity requirements questionnaire.

Health Screening

Please complete the attached PAR(Q) before taking part in any exercise program. If you are between the ages of 14 and 69 and do not exercise regularly you are strongly advised to consult your GP. Your signature at the foot of this form confirms that you understand the risks involved in exercise, have given your INFORMED CONSENT and are participating at your own free will in an exercise programme.

About Exercise Programmes

EXERCISE PROGRAMMES are designed to improve Cardiovascular (heart and lung) Fitness, Muscle Tone and Strength and Endurance and Flexibility and may include physical activities such as Running, Stretching, Lifting Weights and using Gym Equipment/Machines. Each part of the program and each exercise will be fully explained to you, PLEASE ask questions if you are not clear about anything. Please also notify the coach if you feel you should not do a particular exercise for ANY reason. This form will be passed to your coach to make them aware of your current fitness.

Any EXERCISE PROGRAM contains certain risks. Muscle pulls, Joint strains, Aches, Pains and general discomfort from parts of the body not previously used. The program is designed to minimise these risks. However, if at any time during and exercise session you feel pain or discomfort YOU MUST STOP IMMEDIATELY and inform the coach. 

You are advised to talk to your GP if you answered Yes to any of the questions in the PAR(Q) attached. There are many activities you still may be able to do. You are advised to start slowly and increase your level of activity slowly whatever level you are currently at.

I hereby state that I have read, understood and answered all questions in the attached PAR(Q) truthfully. Any queries have been answered to my satisfaction. I also state that I wish to participate in the range of activities including cardiovascular and resistance (weight bearing) exercise. I realise that these activities involve the risk of injury or even death. I am also happy for the gym staff and its coaches to contact me by email or otherwise on any matters involving my exercise program or promotions the gym may have.


Name *
Date of Birth *
Date of Birth
Month - Date - Year
Are you pregnant? *
Have you ever been told by your doctor you have a heart condition? *
Do you get chest pains in activity or when you exercise, feel faint or suffer dizzy spells? *
Do you have high/low blood pressure? *
If yes, are you being treated for it? *
Are you diabetic / epileptic / asthmatic? *
Do you have arthritis or a joint problem which maybe aggravated by exercise? *
Have you suffered from any serious illness or had major surgery in the last 6 months? *
Do you take regular medication? *
Do you suffer from back pain/mobility pain? *
Do you smoke? *
Do you know of any reason why you should not take part in exercise? *
Please sign your full name here *
Please sign your full name here
Pay As You Go client - In addition to the above, I hereby state that I am familiar with the use of gym equipment and that I am able to exercise in the gym unsupervised