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Select a Bootcamp Monday July 3 – Wednesday August 30, 2023 (X classes Total)

Health Waiver forms are only valid for one full year.

I agree to inform ETS of any changes to my health during this year which may affect my ability to participate in this or future programs. Yes.

Informed Consent for Exercise Testing &/or Programming of Apparently Healthy Adults (without known heart disease)

1. Purpose & Explanation of Testing &/or Programming

I hereby consent to voluntarily engage in exercise testing and/or exercise programming. I certify that I am in good health and have had a physical examination conducted by a licensed physician in the last 12 months. Further, I hereby represent and inform Energy Training Systems that I have accurately completed the pre-test &/or pre-programming interview. I have provided correct responses to the questions indicated on the following forms (if applicable): PAR-Q+, ePARmed-X, Lifestyle Information Form. I understand that, if necessary, I will obtain the consent of a physician prior to participating in any testing &/ or programming. I understand that it is important that I provide complete and accurate responses to Energy Training Systems and recognize that my failure to do so could lead to possible unnecessary injury to myself. It is my understanding and I have been clearly advised that it is my right to request that a test &/or exercise be stopped at any point if I feel unusual discomfort or fatigue. I have been advised that I should, immediately upon experiencing any such symptoms or if I so choose, inform Energy Training Systems that I wish to stop the testing &/or exercises at that or any other point. My wishes in this regard shall be absolutely carried out.

2. Risks

It is my understanding and I have been informed that there exists the possibility of adverse changes during testing or exercising. I have been informed that these changes could include abnormal blood pressure, fainting, disorders of heart rhythm, stroke, and very rare instances of heart attack or even death. Every effort, I have been told will be made to minimize these occurrences by preliminary examination and by precautions and observations made during testing &/or exercising. I understand that there is risk of injury, heart attack, stroke or even death as a result of my performance of this test &/or exercises, but knowing those risks, it is my desire to proceed as herein indicated.

3. Confidentiality and Use of Information

I have been informed that the information obtained from this exercise test or program will be treated as privileged and confidential and will consequently not be released or revealed to any person without my express written consent or as required by law. Any information obtained will be used only by Energy Training Systems to evaluate my exercise status or needs.

4. Inquiries and Freedom of Consent

I have been given the opportunity to ask questions about the testing &/or program procedures.

2023 PAR-Q+

The Physical Activity Readiness Questionnaire for Everyone

The health benefits of regular physical activity are clear; more people should engage in physical activity every day of the week. Participating in physical activity is very safe for MOST people. This questionnaire will tell you whether it is necessary for you to seek further advice from your doctor OR a qualified exercise professional before becoming more physically active.

GENERAL HEALTH QUESTIONS

Please read the 7 questions below carefully and answer each one honestly. By submitting your registration below you acknowledge that your answer to all of the questions is NO. If your answer to any of the questions is YES then you need to download and complete the Full PAR Q form on this page.

1) Has your doctor ever said that you have a heart condition OR high blood pressure? - NO
2) Do you feel pain in your chest at rest, during your daily activities of living,OR when you do physical activity? - NO
3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months? Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise). - NO
4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)? - NO
5) Are you currently taking prescribed medications for a chronic medical condition? - NO
6) Do you currently have (or have had within the past 12 months) a bone,joint, or soft tissue (muscle,ligament, or tendon) problem that could be made worse by becoming more physically
active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active. - NO
7) Has your doctor ever said that you should only do medically supervised physical activity? - NO

If you answered NO to all of the questions above, you are cleared for physical activity. By submitting your registration below you acknowledge that your answer to all of the above questions is NO. If your answer to any of the questions is YES then you need to download and complete the Full PAR Q form on this page.

- Start becoming much more physically active - start slowly and build up gradually. Follow Global Physical Activity Guidelines for your age (https://www.who.int/publications/i/item/9789240015128).

- You may take part in a health and fitness appraisal.

- If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal effort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.

- If you have any further questions, contact a qualified exercise professional.

PARTICIPANT DECLARATION

If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider must also submit this registration form. I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that the community/fitness centre may retain a copy of this form for records. In these instances, it will maintain the confidentiality of the same, complying with applicable law.

Delay becoming more active if:

a) You have a temporary illness such as a cold or fever;it is best to wait until you feel better.

b) You are pregnant - talk to your health care practitioner, your physician, a qualified exercise professional, and/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.

c) Your health changes - answer the questions on Pages 2 and 3 of this document and/or talk to your doctor or a qualified exercise professional before continuing with any physical activity program.

Next Steps

You must fill out and submit the Par-Q+ Form if you answered YES to any of the above questions. We will also require this form to be signed by your physician to indicate that you are able to participate in our fitness programs. If you have not already downloaded and submitted the form, you can do so below. Please note if you download the Par Q it is completely fillable and signable without having to print it off.

Download the Par-Q+ Form, fill it out according to the instructions and submit the form separately.

Note: If you answer “YES” to any of the questions on the PAR-Q+ you must have your doctor complete the PAR MED-X as well.

Download Form

Full Registration fee must accompany all registration forms – no refunds once registered.
Payment can be made via paypal or interac e-transfer to alex@etsfitness.ca.

DON'T FORGET TO SUBMIT YOUR REGISTRATION BELOW!

RELEASE AND INDEMNITY: I, the participant, on behalf of myself, members of my family, my heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless Alex Kotai, Energy Training Systems and his representatives and agents for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in any ETS programming and notwithstanding that the same may have been contributed to or occasioned by the negligence of the above listed parties or their representative or agents.