Modified Par Q And You - The Wave (Page 2 of 2) in pdf

Modified PAR Q and You

- page 2

Informed Use of the PAR – Q:

The Wave and their agents assume no liability for persons who undertake

physical activity, and if any person is in doubt about increasing their physical activity after completing this questionnaire,

consult your doctor prior to physical activity.

EXPRESS ASSUMPTION OF RISK:

I, the undersigned, hereby expressly and affirmatively state

that I wish to participate in exercise and/or activity at The Wave. I am aware that if I answered yes to one or more of the

questions on the Modified PAR – Q & YOU form that I am at increased risk for injury or death while participating in exercise

or activity at The Wave. I also understand that it is the recommendation of The Wave to speak with a doctor by phone or in

person to discuss exercise guidelines or limitations BEFORE you start utilizing The Wave.

I realize that my participation involves risks of injury, including but not limited to strains, sprains, heart attack, stroke or even

death. I also recognize that there are many other risks of injury, including serious disabling injuries that may arise due to my

participation in these exercises or activities. I understand it is not possible to specifically list each and every individual injury

risk. However, knowing the material risks and appreciating, knowing, and reasonably anticipating that other injuries and even

death are a possibility, I hereby expressly assume all of the delineated risks of injury, all other possible risk of injury, and even

risk of death, which could occur by reason of my participation.

Printed Name: __________________________________________ Signature: ___________________________________

Date: _________________________________________________ Date of Birth: ________________________________

I, ________________________________ am the parent or guardian of _________________________________ and execute

this release on his or her behalf.

Signature: _____________________________________________ Date: ______________________________________

RELEASE OF LIABILITY:

I have read, completed and understand this questionnaire. Any questions I had

were answered to my full satisfaction. I understand the potential risk of illness, injury or aggravation of pre-existing conditions.

I consent to emergency treatment, including the administration of whatever medication deemed necessary by emergency

medical personnel for my care in the event of injury of illness. I understand the performance of any exercise is my responsibility

and NO EXERCISE IS MANDATORY. I also understand that I must notify The Wave of any changes in health status which

would cause me to answer yes to any of the eight PAR – Q questions. With this understanding I release The Wave, its agents,

and employees from liability associated with my own negligence in participating in my exercise program.

Printed Name: __________________________________________ Signature: ___________________________________

Date: _________________________________________________ Date of Birth: ________________________________

I, ________________________________ am the parent or guardian of _________________________________ and execute

this release on his or her behalf.

Signature: _____________________________________________ Date: ______________________________________

1250 Baker Avenue.

Whitefish, Montana 59937

406-862-2444

Fax 862-1844

Modified Par Q And You - The Wave Page 2