Pre-Exercise Screening – Young People

Young Person's Details

Young person's full name

Date of birth

Age

Gender

Parent / guardian

Parent / guardian full name

Relationship to young person

Parent mobile

Parent email

Emergency contact name

Emergency contact phone

Stage 1

Compulsory

Answer each question about your child. If you're not sure, choose Don't know. Any Yes or Don't know answer needs to be talked through with your exercise professional before your child starts exercising.

10. Current activity

In the past 7 days, on how many days was your child physically active for a total of 60 minutes or more?

Count any activity that raises their heart rate: sport, PE, playing, walking or riding to school, training.

Parent / Guardian Declaration

Stage 1

To the best of my knowledge, all the information I have given in this screening form is correct. I will tell the exercise professional (and my child's health care providers, where relevant) if any of this information changes.

Parent / guardian signature (sign in the box below)

Sign above

Parent / guardian name (printed)

Date

Stage 2

Recommended

Best completed with your exercise professional. These answers help plan training that suits your child.

11. Does your child take any medications or supplements regularly?

12. Does your child have a current health management or action plan (e.g. asthma, anaphylaxis, diabetes)?

13. Has your child ever had a heat-related illness (e.g. heat exhaustion or heat stroke)?

14. Has your child been admitted to hospital in the last 12 months?

15. Does your child have any muscle, bone or joint problems or pain that get worse with activity?

16. Has your child had a concussion in the last month?

Optional: is the young person pregnant, or have they given birth in the last 12 months?

17. Weekly physical activity

For each type of activity your child does in a usual week, tick Yes and enter how often and for how long.

Activity	Does it?	Times / wk	Mins each

Total structured activity per week (sport, PE, school activity, active travel, other). Guideline: 60+ minutes every day, about 420+ minutes a week.

0 MIN / WK

Sleep

School nights: usual bedtime

School days: usual wake time

Weekend nights: usual bedtime

Weekend days: usual wake time

Sleep: —

Screen time (outside school work)

Average hours per school day over the last week.

TV, movies, streaming

Video games

Social media, texting, messaging

Internet / browsing / other

Total: — hrs per day

Above the guideline of no more than 2 hours of recreational screen time per day.

Australian 24-hour movement guidelines (5–17 years)

60+ minmoderate to vigorous activity every day

3+ daysa week of vigorous activity and muscle & bone strengthening

8–10 hrssleep a night (9–11 hrs for 5–13 yrs, 8–10 hrs for 14–17 yrs)

≤ 2 hrsrecreational screen time a day

Goals and notes

What would your child like to get out of training?

Anything else Michael should know?

Parent Consent & Training Policies

Signature required

Consent

I consent to my child taking part in personal training, and following exercise programs written for them, with Michael Lea Personal Training. I understand that some training may be done without a trainer present (for example, at a gym following a program in an app), and that my child should follow the program as written, stop if they feel pain, dizziness or unwell, and tell Michael straight away. Michael may contact my child about their training by app, text or email, and I'll be kept in the loop (copied in or able to see messages). I'll let Michael know straight away about any new injury, illness or change in medication.

Cancellation / Rescheduling

If you need to cancel or reschedule a session, please call Michael Lea on 0414 183 715. If I'm not in, be sure to leave a message. I will check availability and get back to you with confirmation of the rescheduled date and time.

12 hours notice is required for a cancellation or rescheduling in order to receive credit for the session. Failure to cancel within this time frame, or failure to show up for a session, will result in the client being charged for the session. Exceptions will only be made in the case of a medical emergency accompanied by a doctor's note.

All sessions are to be paid cash upfront for the week.

Tardiness

Clients are expected to begin working out at the start time of the scheduled appointment. A late start does not entitle a client to a session longer than the scheduled appointment.

Expiration Dates on Packages

Any sessions that remain after the expiration date will be forfeited: 1 session — 1 month from date of purchase • 5 sessions — 2 months • 10 sessions — 3 months.

As parent / guardian, I give the consent above, and I understand and will abide by these policies.

Parent / guardian signature — consent & policies

Sign above