LLH Family Fitness Live Class Registration
April 11-June 27
Free of charge
July 11-August 29 (No class Aug 1)
Join Zoom Meeting
Meeting ID: 680 080 5290
Please fill out all the names of your family that will participate in the class.
First Name, Last Name
PAR-Q (Physical Activity Readiness Questionnaire)
Please check the box if you, or any of your participating family members, answer "YES" to the following questions.
1) Has your doctor ever said that you have a heart condition OR high blood pressure ?
2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do physical activity?
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).
4) Have you ever been diagnosed with another chronic medical condition (other than heart disease or high blood pressure)?
5) Are you currently taking prescribed medications for a chronic medical condition?
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?
7) Has your doctor ever said that you should only do medically supervised physical activity?
I agree that I will follow all reasonable instructions and directions of the staff, agent and volunteer duly appointed by the Light and Love Home (LLH) in connection with the operation of the above named course.
I hereby release, remise, and forever discharge the LLH, its agents or volunteers, of and from all manner of action, cause of actions, claims and demands of whatever nature which result from any accidental injury, loss or expense sustained, arising out of or in any way connected with participation in any activities and or program, or attendance at any location operated by the LLH.
I authorize LLH to use any photographs or video footage taken while participating the activities for LLH brochure, and promotional materials and purposes.
I give consent to LLH to send me promotional emails regarding their events.
In the event that I am injured, ill or in need of medical attention, I authorize the LLH staff to seek medical attention on my behalf.
Assumption of Risks
I am aware that participation in physical activity involves various risks, dangers and hazards, including but not limited to the risk of abnormal blood pressure, fainting, dizziness, disorders of heart rhythm, and in very rare instances heart attack, stroke, serious injury or death. I further understand that I have been informed that there exists the risk of bodily injury including, but not limited to, injuries to the muscles, ligaments, tendons and joints of the body. I understand that it is my responsibility to learn about and understand the risks, dangers and hazards of participating in physical activity and that I may contact an instructor or staff member if I require more information on these risks, dangers and hazards.
By checking "Yes", I understand and agree with the above.
Send me a copy of my responses.
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