Ymca Personal Training Questionnaire (Page 6 of 15) in pdf

Informed Consent for Fitness Testing and Exercise Participation

Name:

(please print)

Fitness Testing

The purpose of the fitness-testing program is to evaluate cardio-respiratory fitness, body composition,

flexibility and muscular strength and endurance. The cardio-respiratory fitness test involves a

submaximal test that may include a bench step test, a cycle ergometer test, or a one-mile walk test. Body

composition is analyzed by taking several skinfold measure to calculate percentage of body fat. Flexibility

is determined by the sit-and-reach test. Muscular strength may be determined by an upper-body bench

press test or a lower-body leg extension test. Muscular endurance may be evaluated by the one-minute,

bent-knee sit-up test or the endurance bench press test.

II.

Exercise Participation

I desire to engage voluntarily in the YMCA exercise program in order to attempt to improve my physical

fitness. I understand that the activities are designed to place a gradually increasing workload on the

cardiorespiratory system and thereby attempt to improve its function. The reaction of the

cardiorespiratory system to such activities cannot be predicted with complete accuracy. There is a risk of

certain changes that might occur during or following exercise. These changes might include

abnormalities of blood pressure or heart rate.

I understand that the purpose of the exercise program is to develop and maintain cardiorespiratory

fitness, body composition, flexibility and muscular strength and endurance. A specific exercise plan will

be given to me, based on my needs and interests and my doctors recommendations. All exercise

programs include warm-up, exercise at target heart rate and cool down. The programs may involve

walking, jogging, swimming, or cycling (outdoor and stationary); participation in exercise fitness, rhythmic

aerobic exercise, or choreographed fitness classes; or calisthenics or strength training. All programs are

designed to place a gradually increased workload on the body in order to improve overall fitness. The

rate of progression is regulated by exercising to target heart rate and rate of perceived exertion.

I affirm that I am responsible for monitoring my own condition throughout the tests and/or exercise program, and should

any unusual symptoms occur, I will cease my participation and inform my instructor of the symptoms.

In signing this consent form, I affirm that I have read this form in its entirety and that I understand the description of the

tests and their components. I also affirm that my questions regarding the fitness-testing program have been answered to

my satisfaction.

In the event that a medical clearance must be obtained prior to my participation in the fitness-testing program, I agree to

consult my physician and obtain written permission from my physician prior to the commencement of any fitness tests.

Also, in consideration for being allowed to participate in the fitness training and/or exercise program, I agree to assume

the risk of such testing or exercise, and further agree to hold harmless the YMCA and its staff members conducting such

testing and/or the exercise program from any and all claims, suits, losses, or related causes of action for damages,

including, but not limited to, such claims that may result from injury or death, accidental or otherwise, during, or arising in

any way from the testing or exercise program.

Signature of Participant

Date

Person Administering Test

Date

Personal Trainer

Date

Ymca Personal Training Questionnaire Page 6

Related Articles

Related forms

Related Categories