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Disclaimer, please read carefully. By completing and submitting Valkyrie Personal Training and Massage’s PAR-Q, you are confirming you have read and agreed the disclaimer. All completed questionnaires will be kept confidential and not shared with any third parties.

You should always consult your physician or other healthcare provider before changing your diet or starting an exercise program.

I understand that there is a risk of injury associated with participating in any exercise programme run by Valkyrie Personal Training and Massage. I have answered all questions truthfully and to the best of my knowledge and I will inform the instructor of any change in my health.

I hereby assume full responsibility for any and all injuries, losses and damages that I incur while attending, exercising or participating in any Valkyrie training sessions. I hereby waive all claims against Valkyrie Personal Training and Massage, its instructors, or partners of individually or otherwise, for any and all injuries, claims or damages that I might incur.


    Full Name *

    Address *

    Email Address or Contact Phone Number *

    Emergency Contact Name and Number *
    Who should we contact if you become sick or injured

    What is your main reason(s) for taking up an exercise programme?

    Do you suffer from any of the following? *
    AnginaBack ProblemsDiabetesEpilepsyJoint ProblemsAsthmaChest PainsDizzy spellsHigh Blood PressureAre you pregnant?Any other medical conditions?

    Have you recently had an operation or illness? *

    Are you taking any medication of which the instructor should be aware of? *

    Has your Doctor ever said that you have a heart condition? *

    Is there any other reason why you should not participate in physical activity? *

    Do you have any injuries or problems that might restrict or be worsened by your participation in an exercise programme? *

    If you have answered yes to any of the above, please give details: