Polsky's Strength & Conditioning - Waiver & Health Info

Express assumption of risk:

I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls which can result in serious injury or death; injury or death due to negligence on the part of myself, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under direction of Polsky's Strength & Conditioning. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.

In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Polsky's Strength & Conditioning, I, the undersigned hereby release Polsky's Strength & Conditioning, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with Polsky's Strength & Conditioning to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.

The participant recognizes that there is risk involved in the types of activities offered by Polsky's Strength & Conditioning. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Polsky's Strength & Conditioning, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Polsky's Strength & Conditioning, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by Polsky's Strength & Conditioning.

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

Physical activity improves your physical and mental health. Even small amounts of physical activity are good, and more is better.
For almost everyone, the benefits of physical activity far outweigh any risks. For some individuals, specific advice from a Qualified Exercise Professional (QEP – has post-secondary education in exercise sciences and an advanced certification in the
area) or health care provider is advisable. This questionnaire is intended for all ages – to help move you along the path to becoming more physically active.

The following questions will help to ensure that you have a safe physical activity
experience.

PLEASE RECORD ALL YES ANSWERS IN THE TEXT BOX BELOW.

1 Have you experienced ANY of the following (A to F) within the past six months?

A A diagnosis of/treatment for heart disease or stroke, or pain/discomfort/pressure
in your chest during activities of daily living or during physical activity?

B A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?

C Dizziness or lightheadedness during physical activity?

D Shortness of breath at rest?

E Loss of consciousness/fainting for any reason?

F Concussion?

2 Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active?

3 Has a health care provider told you that you should avoid or modify certain types of physical activity?

4 Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis, asthma, spinal cord injury) that may affect your ability to be physically active?
(ANSWER ABOVE QUESTIONS BELOW IN FIRST AND 2 QUESTION OPTIONS)

Answer the following questions to assess how active you are now.

1 During a typical week, on how many days do you do moderate- to vigorous-intensity aerobic physical activity (such as brisk walking, cycling or jogging)? DAYS/WEEK

2 On days that you do at least moderate-intensity aerobic physical activity (e.g., brisk walking), for how many minutes do you do this activity? MINUTES/WEEK

For adults, please multiply your average number of days/week by the average number of minutes/day: MINUTES/DAY

(ANSWER THE ABOVE QUESTIONS BELOW IS SECOND QUESTION OPTION)

If my health changes, I will complete this questionnaire again.
DECLARATION

Canadian 24-Hour Movement Guidelines recommend that adults accumulate at least 150 minutes of moderate- to vigorous-intensity physical activity per week. For children and youth, at least 60 minutes daily is recommended. Strengthening muscles and bones at least two times per week for adults, and three times per week for children and youth, is also recommended

Increase your physical activity gradually so that you have a positive experience. Build physical activities that you enjoy into your day (e.g., take a walk with a friend, ride your bike to school or work) and reduce your sedentary behavior (e.g., prolonged sitting).
If you want to do vigorous-intensity physical activity (i.e., physical activity at an intensity that makes it hard to carry on a conversation), and you do not meet minimum physical activity recommendations noted above, consult a Qualified Exercise
Professional (QEP) beforehand. This can help ensure that your physical activity is safe and suitable for your circumstances. Physical activity is also an important part of a healthy pregnancy. Delay becoming more active if you are not feeling well because of a temporary illness.

PSC PAD Form

I authorize Polsky’s Strength & Conditioning Ltd. and its Financial Institution/Payment Processing Company to debit my bank account for a monthly membership to Polsky’s Strength & Conditioning Ltd.
AND/OR
- additional packages that I have registered for.
- merchandise/product I have purchased via product purchase sheet.

I understand that Polsky’s Strength & Conditioning Ltd.will debit my bank account on a monthly basis in the amount we have agreed upon and the date of withdraw will be based on the date that I signed up for this membership.

I have supplied Polsky’s Strength & Conditioning Ltd. with valid banking information.

In signing this PAD Agreement, - If I am registering for a Monthly Unlimited Membership, I give Polsky’s Strength & Conditioning Ltd. a commitment of 90 days beginning on date of signature. I am aware that this is a commitment to myself, to improving my health and attaining my goals. If I choose to terminate my membership after this 90 day period, I must give notice 30 days before the beginning of a new billing cycle (billing cycles based on the date that the gym membership acquired). For all other reoccurring bills for monthly memberships, a commitment of 1 month is required I must also give notice 30 days before the beginning of a new billing cycle.

I acknowledge that Polsky’s Strength & Conditioning Ltd. does not allow memberships to be placed on hold for reasons other then doctors advised medical leave (injury) or out of country travel greater then 1 month with documentation

I further understand that Polsky’s Strength & Conditioning Ltd. will debit my account when I purchase additional packages, either through one time purchase or recurring packages that I have signed up for. I also understand PSC Ltd will debit my account for any product or merchandise I purchase via the product purchase sheet. I acknowledge that the amount withdrawn may vary, depending upon what I have registered for/purchased.
Due this variance:
I waive my right to receive pre-notification of the amount of the PAD and agree that I do not require advance notice of the amount of PAD’s before the withdraw is processed.

I understand that Monthly Membership Fees and Fees for Strength & Conditioning Services are subject to annual increases. PSC Ltd will inform all members of said increase 1 month prior to implementation.

I agree to notify administration staff at Polsky’s Strength & Conditioning Ltd.should my Bank Account information change.

I acknowledge that Polsky’s Strength & Conditioning Ltd. will assess a fee of $25 per transaction if the account information provided does not exist, a stop payment is applied, or if a payment is not completed due to NSF (Not Sufficient Funds). I further understand that my membership will be deactivated until my account is in good standing. I also understand that my pass and this agreement will be terminated should there be 2 NSF instances.

I am aware that my bank account will continue to be debited monthly until I give written notice to cancel pre-authorized debit. I must give notice 30 days before the beginning of a new billing cycle (billing cycles based on the date that the gym membership acquired). If a cancellation request is received later than 30 days before the billing date, the membership will remain active for an additional month. There will be no refunds for unused portions of a month. At the time of cancellation, Polsky’s Strength & Conditioning Ltd. reserves the right to utilize this PAD for any balances on my account or unpaid invoices. To obtain a sample cancellation form, or for more information on my right to cancel a PAD Agreement, I may contact my financial institution.

I have certain resource rights if any debit does not comply with this agreement. For example, I have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on my resource rights, I can contact my financial institution

The date my membership begins is the date my payments will begin at Polsky’s Strength & Conditioning Ltd. and is the date each month my account with be debited for my Monthly Membership Fee.