Coaching Registration

Thank you for your interest in coaching.
1) Please select the coaching program, series or workshop you are interested in.

2) You must also complete the Physical Activity Readiness Questionnaire (below this form) if you are registering for a fitness workshop, a series or CK Vitality+ program or anything that includes physical training (i.e. workouts in any format, personal or group training, live recorded training).

Note: The information collected from this registration form is for the sole purpose of communicating with regarding next steps to fully register for one of coaching. This information will not be shared.

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Physical Activity Readiness Questionnaire (PAR-Q)

Regular physical activity is fun and healthy, and more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below.

If you are between the ages of 16 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and are not used to being very active, check with your doctor.

Common sense is your best guide when answering these questions. Please read carefully and answer each one honestly: select YES or NO.

Notes: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the 7 questions. The information collected from this questionnaire.is for the sole purpose of verifying your ability and physical readiness to participate in physical activity safely. This information will not be shared.

PAR-Q

1. Has your 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 a chest pain when you were not doing physical activity?

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

5. Do you have a bone or joint problem (for example, back, knee, or hip) that could be made worse by a change in your physical activity?

6. Is your doctor currently prescribing medication for your blood pressure or heart condition?

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

8. Are you pregnant or have you had a baby less than six weeks ago?

Having answered YES to one of the above, I have sought medical advice and my GP has agreed that I may exercise.

I have not sought medical advice.

GP has agreed

I agree

NO to all questions:

I agree

Waiver: I take full responsibility for any risks, injuries, damages, unknown or known, which I might incur as a result of participating in live or recorded online classes or personal training sessions or programming. I knowingly, voluntarily and expressly waive any claim I may sustain as a result or participating in live or recorded online classes and personal training sessions and programming. I understand that Coach Katya is a trained Personal Trainer and Nutrition coach and provides habits and behaviour-based nutrition, fitness and wellbeing coaching. I understand that Coach Katya is not a medical practitioner, a physiotherapist, a certified dietician or a nutritional therapist.

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