Copy and paste the following application:

 

                          How did you hear about this program________________________

    Referer (office use only)____________________________________

 

Ultimate Loser Fall 2010 Application

Application with refundable payment due by September 17th, 2010, 10:00 PM

Turn completed application with payment to the Personal Training Director at the Members Service Desk

Competition is scheduled to start week of September 20th, 2010.   Go to www.appleathleticclub.com/ul_results.php  for competition days and times.

 You could win a 6-month membership and 10 sessions with a personal trainer worth over $1,000!
Please Read Carefully
1-Registration Information
Last Name: _____________________ First Name: ____________________ D.O.B: _____/_____/_____
Address: _________________________________ City: ________________ State: ______ Zip _______
Day Phone: _______________ Evening Phone: ______________ Email:_________________________
Emergency Contact: __________________________________ Phone: __________________________
Are you a member of Apple Athletic Club? (yes/no)_______
What is your total weight loss goal? _____ Lbs.
Possible Work Out Times: First Choice: _________ Second Choice: ________ Third Choice: _______

 

 

 

2- Physical Activity Readiness Questionnaire (PAR-Q)   

          (circle one)                             
1.    Has a doctor ever said you have a heart condition and recommended only medically supervised activity?      Yes      No
2.    Do you have chest pain brought on by physical activity?   Yes      No
3.    Do you tend to lose consciousness or fall over as a result of dizziness?  Yes      No
4.    Has a doctor ever recommended medication for your blood pressure or a heart condition?  Yes      No
5.    Do you have a bone or joint problem that could by aggravated be the proposed physical activity?  Yes      No
6.    Are you aware, through your own experience or been warned by a doctor, or any other physician against your exercising without medical supervision?     Yes     No
7.    Are you over the age of 65 and not accustomed to vigorous exercise?    Yes      No
If you answered YES to one or more of the above questions, please answer the following questions:
8.    Have you consulted with your physician regarding increasing your physical activity and/or performing  fitness assessment?  Yes    No
9.    If you answered NO to question 8, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?     Yes     No

10. If you answered yes to any of the above questions, you should visit your physician before participation.   Tell your physician which question(s) you answered yes.  Ask if you are healthy enough to participate in an exercise program.

All Participants Should Visit Their Physician Before Participation

3-Pre-Exercise Questionnaire
1.       Current Resting Heart Rate: ______ bpm   Current Blood Pressure: ______/______ (you can measure these at Apple upstairs behind the main stairs)
2. Do you have a time frame in mind for accomplishing your health and fitness goals? If so, what is it?
3.        Does your job require any of the following (circle one)?
1. Prolonged sitting or driving   2. Moderate movement   3. Heavy lifting   4. Repetitious lifting or twisting  5. Night shift
4. Are you currently participating in an exercise program?      Yes      No
5. If so, how long consistently?  < 3 months     3 months to 1 year     > 1 year
6. How many days a week is it realistic for you to be working out at the gym?1  2  3  4  5  x per week
7. Do you know how many calories you should be eating to reach your goal?                Yes      No
If yes, how many and how do you know?
 
All Participants Should Visit Their Physician Before Participation

Terms and Conditions
1.    Apple Athletic Club's Ultimate Loser:
Apple Athletic Club employees and trade employees are not eligible to win prizes. 
Applicants must be 16 years or older (if less than 18 years, parent or legal guardian must sign PAR-Q and this application)
How To Become Qualified:
Participants may pick up registration forms at Apple Athletic Club or print this application from www.appleathleticclub.com.  Participants must complete forms and return to Apple Athletic Club with $299.00 members or $349 non-members application fee paid by check or credit card at time of registration.  Participants or legal guardian (if less than 18 years) must sign all forms.  An Apple Athletic Club representative will notify all registered participants if participant was chosen for the challenge.  If not chosen, the entire application fee will be refunded immediately:  Checks and credit card information will be destroyed.  Competition will start the following week.  Apple reserves the right to extend competition start date to fill all available teams.
2.    As a chosen participant you will receive:
a.    Each participant will be in a workout group of up to eight participants.  Each group will be assigned a personal trainer for the duration of the challenge.  Your trainer will:
i.    Meet with you and your group twice weekly except in the rare case of trainer absence
ii.    Conduct weekly lectures on your weight loss system
iii.    Aid you in setting up your personal calorie intake and expenditure goals.
iv.    Conduct all group workout sessions.
v.    Recommend additional workout plans during challenge.
vi.    Aid you in setting up your personal meal plan.
3.    Individuals may be sponsored by another individual or business.
4.    Participants Agree To The Following:
a.         Participant must follow all exercise and fitness guidelines set forth by personal trainer:

b.         Participant agrees to submit to blood/urine analysis at the request of Apple Athletic Club if drug use is suspected.  Participant agrees to pay for all costs associated with blood/urine analysis.   
c.         Participants will not participate in unhealthy weight loss programs.  You must adhere to your trainer's minimum calorie intake level.  These will change from person to person because each individual is different.  Your food logs will aide in tracking.
d.    Official weigh-ins dates and times will be arranged.  If you can't attend official weigh-ins, you cannot participate in this contest.
e.         Official Weigh in attire: Shorts and T-Shirt.  Biking shorts and sports bras will also be acceptable.  Pictures could be taken in weigh-in attire.
f.          Participant should attend each weekly unofficial weigh in set up by the group's personal trainer and in normal workout attire.  Participants must attend Official initial and final weigh in. 

g.         Apple Athletic Club will document all results and outcomes, starting with beginning measurements and statistics.  These results and findings will be compiled for analysis, findings to be used for marketing.
h.         Participants agree to take Beginning Photos and After Photos to be used by Apple Athletic Club. Pictures could be taken in weigh-in attire.
i.          Participants agree to allow Apple Athletic Club to use their name(s) and or pictures for promotional purposes in newspaper, TV, website, and radio campaigns with no compensation of any kind due to participant.
All Participants Should Visit Their Physician Before Participation
j.          The Apple Athletic Club Ultimate Loser is a competition.  Apple Athletic Club is promoting healthy weight loss and a healthy life style, but included in this competition, you have the chance to win prizes.  There is no cash value or trade value for these prizes. 

5.  Each participant agrees to the following:
a.         Each winner will be determined by multiplying the percentage of weight loss from the Official weigh-ins by the number of participation points multiplied by 100.  The highest number rounded to the nearest tenth will determine the winners.  In the event of a tie, the prizes will be divided evenly.
b.         Official weigh ins will be rounded to the nearest 1/10th pound.  Official weight change will be verified by the Director of Personal Training who will track Official weight change.
c.         Participation points will be awarded for each entire group personal training session, one per session, maximum of 2 per week.
d.         Participation points will be awarded for working out on your own (must be verified by Apple Athletic Club employee.)  One point is awarded for each 50 minutes of personal workout, maximum of 4 per week.
e.         Total accumulated points cannot exceed 6 per week and 60 for the 10-week challenge. 
f.          There will be one male winner and one female winner.
g.         Participants agree to follow all exercise and fitness guidelines set for by personal trainer for the duration of Challenge not to be more than ten (10) weeks.  Any participant not in compliance with the above terms will automatically be disqualified.
h.         No refunds will be given at any point for any reason. 
i.          Winners must redeem 6-month single membership and 10-session personal training package within 10 days of winner announcement date or all prizes will be forfeited.  All personal training sessions must be completed within 10 weeks of announcement date.
6.       Participant accepts full responsibility for use of Apple Athletic Club and its equipment and services.  I also attest that I am physically able to undertake any and all physical exercise that I may perform at Apple Athletic Club and agree to hold harmless Apple Athletic Club, its agents, affiliates and employees from any and all liability for any claims, injuries, damages, action or causes of action, whatsoever, arising to myself or my property or of such usage of the Apple Athletic Club or its services including the use of a personal trainer.

7.       There will be other rules announced at the initial weigh-in that participant must follow or will be refused participation


________________________________________________________________________
Signature of Applicant (signing acknowledges that you have read entire registration packet)       
Turn in with payment to Director of Personal Training @ Members Service Desk. 

All Participants should get Physician Clearance before Participation

Revised 8/31/10