Lake Fitness No 10

Lake Fitness at No10 is for the exclusively for staff who work within building numbers 1210-1240; 1310-1330; 1410-1430 and 1650

Lake Fitness @ No10 is open from 6am to 8pm Monday to Friday

All exercise classes are bookable online - 7 days in advance

Access to the gym and all classes are included in the membership plan.

Direct debit memberships are for a minimum 3 month period requiring 30 days cancellation notice to info@debitfinance.co.uk

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

This questionnaire has been designed to ensure that you begin activity at Lake Fitness @ No10 quickly and safely. Please complete by ticking the relevant boxes.

YES NO

1. Has a doctor ever said you have a heart condition and that you should only do physical activity recommended by a doctor?

2. Do you feel pain in your chest when you do physical activity?

3. In the past month, have you had chest pain when you were not doing physical activity?

4. Do you lose balance because of dizziness or do you ever lose consciousness?

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?

6. Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or a heart condition?

7. Do you have diabetes mellitus?

8. Are you, or is there any possibility that you are pregnant?

9. Do you suffer shortness of breath at rest or with mild exertion?

10. Do you suffer from unusual fatigue with usual activities?

11. Do you know of any other reason why you should not do physical activity?

CONDITIONS

In consideration of my being given access to the facilities and equipment at Lake Fitness @ No10, I acknowledge that:

1. I am aware of and understand the potential risks and dangers associated with physical activity including the use of equipment and I am voluntarily participating in these activities with knowledge of the risks and dangers involved.

2. To the best of my knowledge I know of no reason why I should not participate in any of the programmes and activities at Lake Fitness @ No10. I hereby declare myself free of any condition, disease, impairment, infirmity or illness that may affect my participation. I agree to inform a member of staff and where appropriate provide written consent from my doctor should such a condition or complaint arise, before continuing with any activity.

3. I agree to abide by all verbal and written notices regarding safety whilst at Lake Fitness @ No10. I agree to use only the equipment and facilities relevant to my capabilities and that I have been inducted on and / or am fully conversant with.

4. I have had the opportunity to ask questions about the activities, use of the equipment and other related issues at Lake Fitness @ No10, and any questions I have asked have been answered to my satisfaction.

5. This questionnaire has been completed accurately to the best of my knowledge and belief.

6. Lake Fitness @ No10 accepts no liability for my death, injury or illness resulting from my failure to disclose any relevant medical impairment or condition or from my misuse of Lake Fitness @ No10 facilities or equipment.

7. Without prejudice to the above, Lake Fitness @ No10 accepts no liability for loss of whatsoever nature and howsoever arising caused to me or suffered by me whilst on Lake Fitness @ No10 premises WITH THE EXCEPTION of any liability or loss that is caused by the negligent acts or omissions of the Club and / or its employees.

I have read and understood this questionnaire and agree to be bound by its conditions.