Operoo

Eastbournian Society Sports Club - Application Form

Please complete the two steps below

STEP 1: Please watch the Gym Induction Video via this link.

STEP 2: Please complete the form below.

Physical Activity Readiness Questionnaire (PAR-Q) & Disclaimer

Please complete the following health questions accurately and to the best of your knowledge. This is to identify the small number of adults for whom physical activity might be inappropriate or those who should seek medical advice concerning the type of activity most suitable for them. All details will be kept confidential.

If you have any questions in relation to this form or gym use, please contact either:

mallchorn@eastbourne-college.co.uk - 01323 452238

es@eastbourne-college.co.uk - 01323 452316

or, Eastbourne College Reception - 01323 452300

First Name *

Surname *

Male / Female *

Male

Female

Date of Birth *

Mobile Telephone Number *

Landline telephone number (if applicable)

Do you give permission for your mobile number to be added to our ES Sports Club Whatsapp group? We will use this to keep you up to date with any changes to opening time or planned maintenance which may effect usage. *

Yes I give permission to be added to the Whatsapp group.

No, I do not wish to be added to the Whatsapp group.

Email address *

Home address *

What is your connection to the College (Staff, parent, OE etc)? *

Questions relating to the medical health of the participant

Do you have a bone or joint problem such as arthritis, which is aggravated by exercise or might be made worse by excercise? *

Yes

To your knowledge, do you have high blood pressure? *

Yes

To your knowledge, do you have low blood pressure? *

Yes

Do you have Diabetes mellitus or any other metabolic disorder? *

Yes

Has your doctor ever said that you have raised cholesterol (serum level above 6.2mmol/L)? *

Yes

Do you have or have you ever suffered a heart condition? *

Yes

Have you ever felt pain in your chest when you do physical exercise? *

Yes

Do you ever feel faint, have spells of dizziness or have ever lost consciousness? *

Yes

Are you, or is there any possibility that you might be pregnant? *

Yes

Have you ever been advised by a doctor to avoid exercise? *

Yes

Do you have any pre-existing injuries at this time? *

Yes

If you have answered YES to any of the above please give details

If you answered YES to one or more questions in section 1:Consult with your doctor before increasing your physical activity and / or taking a fitness appraisal. Inform your doctor of the questions that you answered ‘yes' to on the PAR-Q or present your PAR-Q copy. After medical evaluation, seek advice from your doctor as to your suitability for: 1. Unrestricted physical activity starting off easily and progressing gradually, and 2. Restricted or supervised activity to meet your specific needs, at least on an initial basis.

Section 2

Do you drink alcohol? *

Yes

If yes, do you:

Have the occasional drink?

Have a drink every day?

Have more than a drink every day?

Do you currently smoke? *

Yes

If Yes, how many do you smoke per week?

Have you previously smoked? *

Yes

If yes, how long since you stopped?

Is your doctor currently prescribing you drugs or medication? *

Yes

If yes, what medication?

Is there any history of Coronary Heart Disease within your family? *

Yes

Procedure and Disclaimer
We would like to thank you for taking the time to complete the PAR-Q. We would also like to notify you that the information given is completely confidential and will only be seen by Eastbourne College staff members that need to view it. If you have answered YES to any questions in section 1, please seek clearance from your doctor before attending.

Assumption of Risk

I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in exercise which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involve the risk of injury and even the possibility of death, to which Eastbourne College are not liable. I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.

College Gym Code of Conduct

The following terms and times outline the Eastbourne College code of conduct for the College Gym and applies to all gym users. Any breach of the following rules could result in your suspension from the College Gym at the discretion of the Director of Sport.

College Gym

1. The College Gym opening times for ES Sports Club members are as advertised. Any updates and changes will be sent via e-mail when required.

2. Wash hands properly in the toilets next to the gym before entering. Take note of new non-negotiable rules of using the College gym, posted on the walls.

3. 35 person limit in the gym. Please wait outside (no crowding in corridors) for 1 in, 1 out if necessary. At discretion of staff on duty.

4. Normal College rules apply at all times and any misconduct will be dealt with appropriately or a ban on using the gym for a period of time. This includes any issues during transit to and from the gym.

5. Appropriate kit must be worn whilst using the gym. No vests or crop tops as examples.

6. No speakers are to be brought into the gym; if you want to listen to music, use your own headphones.

7. No filming is allowed in the gym. Only staff can film if for educational purposes such as coursework.

8. Keep the gym tidy; even if it is not your mess. All equipment must be returned and any rubbish must be placed in the bins provided. Wash / sanitise hands having done so and during the session.

9. Wipe down any equipment you’ve used and put any tissue paper in the bins provided.

10. Bring your own water bottle already filled, the water dispenser is out of use currently. No eating.

11. Always shut the door behind you, do not prop it open – because of site security / safeguarding. You therefore must have your access card.

12. If you are unsure of how to use a piece of equipment, or perform a certain exercise, ask a member of staff. Do not attempt without guidance.

Free Weights and Cardio Equipment:

13. Any weights which are taped up are not to be used at present.

14. Do not drop weights; this counts as vandalism.

15. All equipment (e.g. plates, barbells, dumbbells, kettlebells, and foam rollers) must be returned to where it is stored after use.

16. When using free weights there must be a spotter/buddy present

17. Cardio Equipment must be used for no other purpose than that for which it was intended, and must be wiped down after use.

18. ES Sports Club members may gain access to the gym by filling in a PAR-Q on Operoo and watching the induction video by Head of Strength and Conditioning (Dan Sheppard)

19. E Sports Club members can only use the gym at set times and must not use the facility at the same time as pupils or during PE lessons.

By signing this form I agree that I have read and will abide by the above Procedure and Disclaimer, Assumption of Risk and the College Code of Conduct, and that I have watched the induction video *

Signature *

Today's date *

Section 3

Please indicate which of the following memberships you fall under *

Eastbournian Society (including OE's, OA's, parents of current pupils, OE's and OA's)

Holroyd Howe