Prenatal And Postpartum Fitness Registration | Progressive Elite Training, Penticton

Register online for Prenatal And Postpartum Fitness Registration

Name:

Email:

Address

City

Province/State

ZIP

Country

Cell Phone

Home Phone

Pelvic Floor Therapist

Name of Doctor

& Phone Number

Name of Emergency Contact

& Phone Number

Does your health care provider know you are taking part in a fitness program?

yes no

Has he / she cleared you for exercise?

yes no

Is this your first pregnancy?

yes no

If yes, have you had any prior complications or resulted in a loss of pregnancy?

yes no

If yes please describe:

Do you have any issues regarding low back?

yes no

If so explain:

Do you have any issues regarding shoulder, knee or any other pain that would effect our training?

yes no

How many weeks pregnant are you?

Has your health care provider diagnosed any complications with your pregnancy? If yes please list the complications.

During this pregnancy have you experienced any of the following:

Vaginal Bleeding or spotting

yes no

Faintness or dizziness

yes no

Fetus not growing to rational age

yes no

Lack of weight gain

yes no

Excessive swelling

yes no

Extreme fatigue

yes no

Extreme nausea or vomitting

yes no

Did you exercise before this pregnacy?

yes no

If yes, what type are you doing?

Intensity? Duration? Frequency?

Have you experienced any difficulties with your current fitness routine since becoming pregnant? If yes please describe

What are your exercise goals during pregnancy?

Choose your Package/Price

(tax not included)

Before starting any fitness/health/nutrition program it is wise to seek your doctors advice.

RELEASE FORM AND LIABILITY WAIVER. PLEASE READ, CHECK THE BOXES AND SIGN BELOW.

This release is entered into between the undersigned and Progressive Elite Training, its officers, subsidiaries affiliates, and executors in addition to the city of Penticton. The purpose of Progressive Elite Training is to provide fitness instruction and coaching for various levels of athletes/individuals

The undersigned hereby acknowledges that the following was explained to me and or agree to the following:

acknowledges that Sheila Kamaraus is not a physician and is not trained in any way to provide medical diagnosis, medical treatment, or any other type of medical advice.

exerciser hereby stipulates that he/she is physically sound and that he/she has approval to proceed with a routine of exercise.

LIMITATIONS OF EXERCISE IF ANY: it is further expressly agreed that all strength training, cardiovascular exercise, or any other exercise shall be undertaken by me at my sole risk and that Sheila Kamaraus her agents or employees shall not be liable to me for claims, demands, injuries, damages, actions or causes of action whatsoever, to my person or property arising out of or connected with the use by me of the services provided and of the premises where the same is located . I do hereby expressly forever release and discharge Sheila Kamaraus and her agents or employees from all such claims, demands, injuries, damages, actions or causes of action, from all acts of active or passive negligence on the part of Sheila Kamaraus and her agents or employees.

acknowledges that the undersigned has been told if they feel tired, feel pain or feel out of the ordinary in any way either related to your training, or otherwise, that the undersigned should contact a physician at once.

acknowledges that running, hills, stairs, obstacle courses and any other related sports are an extreme test of one's mental and physical limits and carries with it potential for damage or loss of property, serious injury, and death. That the undersigned assumes the risks of participating in these types of events/activities including the elements of a natural environment. That they are fit and they discharge and agree not to sue from any liability of death, disability, personal injury or action of any kind Progressive Elite Training for the undersigned participating in said sporting events and/or training for said sporting events.

the undersigned has entered into this agreement free and voluntarily without force or coercion.

customer client agrees to confidentiality with respect to Progressive Elite Training and all services provided by the same. The undersigned agrees to refrain from disclosing directly or indirectly any and all aspects of Progressive Elite Training. The undersigned agrees to a non-compete within a 50 mile radius of Penticton for a period of 5 years from the date of participation.

DO NOT SUBMIT THIS AGREEMENT UNLESS YOU UNDERSTAND THE TERMS COMPLETELY.
IF YOU DO NOT UNDERSTAND YOU SHOULD SEEK LEGAL COUNSEL.

Decide.Commit.Succeed.