REGISTRATION WITHOUT ONLINE PAYMENT

The professionals of Kinéactif recommand to you to do the PAR-Q while you do your registration :

Cheer! You chose the physical activity to find the form or to preserve healthy practices of life. If you envisage to change your life style or to undertake a new activity, the PAR-Q is a tool which helps us to perceive if the sporting practice will involve for you major risks or requires a medical expertise. Don't worry. For the majority of people, the practice of the physical activity is the best thing which could arrive to them and we hope that it is remains pleasant in any time. Then, read and answer this questionnaire honestly. If you have questions or hesitations, ask the assistance to a kinesiologist or your instructor. The whole document remains entirely confidential..

First name: Last name :
Adress : Appartment :
City : Postal Code :
Province : Phone number :
Birthdate : Phone number at work or cell phone:
If minor name of parent or tuteur : E mail :
Objectives and goals:
Services - Choose one or more

Services (You can register any time )

Summer - FALL -spring
Private inline skating course
In line skating club on pathways

FALL - WINTER - SPRING
INDOOR INLINE SKATING CLUB- full membership
INDOOR INLINE SKATING CLUB - family membership
INDOOR INLINE SKATING CLUB - dimanche matin
INDOOR INLINE SKATING CLUB - Tuesday 7 pm
INDOOR INLINE SKATING CLUB - Thursday 7pm
INDOOR INLINE SKATING CLUB - INTERMEDIATE (SUNDAY 10h00)
Indoor inline skating course for beginner (november to april only)
INDOOR INLINE SKATING CLUB - speed skating (sunday 9h00)
Children Inline skating courses !! ( sunday at 11am)
Slalom on inline skates

The EXPRESS - Physical activities during lunch hour with KINÉACTIF - 211, Montcalm Street- Centre Multisport de la fonderie

Group wor-out - Tuesday and Thursday
Badminton - Monday, Tuesday and Thursday
Inline skating - Wednesday
Volleyball - Monday, Tuesday and Thursday
Pilates and Swiss ball - monday
Walking and running club

Personal services

Fitness Apprasal
Personnal training for weight loss and other objectives
Others


Yes No

Does your doctor have you says that you suffer from a cardiac problem?

Do you feel a pain with the chest when you make physical activity?

During the last month, did you feel pains with the chest during periods other than those where you take part in a physical activity?

Do you lose balance or feel dizzy sometimes? Do you lose consciousness?

Do you have articular problems which could be worst by a modification of your of participation in a physical activity?

Does drugs are they currently prescribed to you to control your blood pressure or a cardiac problem?

Do you know another reason for which you should not make you physical activity?
if yes which?

Do you have respiratory problems?

Do you suffer from diabetes?

Do you have allergies ?
if yes which?

If you are a woman, are you pregnant?
If yes since when?

Are you a smoker ?

RISKS FACTOR OF CORONARY DISEASES
Less than 30 minutes of physical activity on majority of the days of the week?
Accumulation of fat mass around the wait - size?
Do you smoke the cigarette at least 1 time per day ?
Do you have family antecedents of coronary diseases?
Arterial hypertension brought back by your doctor after repeated measurements?
Hyperlipidemy brought back by your doctor?

Waiver

I, _ , am register or I register my child in a course offered by Kinéactif. I recognize that, even if few wounds occur in this field, the practice of this activity involves risks. I recognize that, these risks can vary from one person to another depending on his health, his physical condition like his behaviors opposite to the compliance and the rules put of before in the program or the respect of training principles. These risks are, in a more particular but nonrestrictive way, the following: an abnormal blood pressure, a faintness with the chest, a dizzy spell, cramps, nauseas, an accident following a fall and seldom a heart attack or a drowning.

In all knowledge of cause and accepting the risks of the activity

If I accept a gift as a promotion, the value of the gift can be substract to the value of the contract if the contract is cancelled.

 

frederic@kineactif.com

 

  

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