Clemson University Online Forms

Small Group Training Registration Form

* Denotes a required field

Your Name *

First NameLast Name

Clemson ID/Membership ID *

Your E-Mail *

name@example.com

Phone *

-- Ext.

Age *

Gender *

Membership Type *

Student
Faculty/Staff Member
Community Member

Emergency Contact Name *

First NameLast Name

Emergency Contact Phone *

-- Ext.

Emergency Contact Relationship *

Registering for:

FALL OFFERINGS

SESSION I: October 11 - December 8 (excluding week of Thanksgiving) *

SESSION I: Women on Weights Wed. and Fri. 7am-8am

My main goal during this program is to:


Health History and Physical Activity Readiness Questionnaire (PAR-Q)

Do you have any allergies Clemson Campus Recreation staff should know about?

Are you currently taking any medications the Clemson Campus Recreation staff should be aware of?

Please note: Answering YES to any of the following questions will require written clearance from your physician or medical professional.


Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Yes
No

Do you feel pain in your chest when you do physical activity? *

Yes
No

In the past month, have you head chest pain when you were not doing physical activity? *

Yes
No

Do you lost your balance because of dizziness or do you ever lose consciousness? *

Yes
No

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? *

Yes
No

Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

Yes
No

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

Yes
No


Assumption of Risk and Release of Liability

I understand that the activities in which I participate at Fike Recreation Center may range from strenuous to sedentary. I understand that I, in consultation with my physician, am the best judge of my physical condition, and I will consider this when engaging in various physical exercises at Fike Recreation Center. I have been advised to consult with qualified medical personnel for any injury that I may sustain and to advise Fike Recreation Center personnel should I become dizzy, nauseated, or light-headed, or suffer any sudden or severe pains or any other unusually abnormal physical manifestation during my use of Fike facilities/equipment.

I further understand that the equipment used in exercise programs can be complicated and dangerous if not properly used, and I will seek advice from qualified Fike personnel before using any equipment with which I am not familiar and properly trained.

I further understand that participation in any Small Group Training program at Fike is entirely voluntary on my part. I have been further advised that I am responsible for carrying my own medical insurance and that Fike Recreation Center is not an insurer of my activities.

I understand that I should not participate in any activities at Fike Recreation Center while under the influence of drugs (unless specifically approved by my physician) or alcohol.


Please sign below: *

Date: *

Please continue on to the next page to complete the Health History and Physical Activity Readiness Questionnaire (PAR-Q)