155 Military Road, Lancaster, Ontario K0C-1N0

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Gym Pass

Prepaid (Paid in Full)

  • Client's Information

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  • Health Questionnaire (PAR-Q)

    A questionnaire for people aged 16 to 69.
  • Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

    If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

    Common sense is your best guide when you answer this questionnaire. Please read the questions carefully and answer each one honestly: check YES or NO.

  • Yes No
    Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
    Do you feel pain in your chest when you do physical activity?
    In the past month, have you had chest pain when you were not doing physical activity?
    Do you lose balance because of dizziness or do you ever lose consciousness?
    Do you have bone or joint problem (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
    Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition?
    Do you know of any other reason why you should not do physical activity?
  • If you answered YES to one or more questions.

    Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

    • You may be able to do any activity you want — as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice.

    • Find out which community programs are safe and helpful for you

    If you answered NO to all questions.

    If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can:

    • Start becoming much more physically active – begin slowly and build up gradually. This is the safest and easiest way to go.

    • Take part in a fitness appraisal – this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively. It is also highly recommended that you have your blood pressure evaluated. If your reading is over 144/94, talk with your doctor before you start becoming much more physically active.


    • If you are not feeling well because of a temporary illness such as a cold or a fever – wait until you feel better; or

    • If you are or may be pregnant – talk to your doctor before you start becoming more active

    PLEASE NOTE: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional.

    Ask whether you should change your physical activity plan.

    Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.

    No changes permitted. You are encouraged to photocopy the PAR-Q but only if you use the entire form.

    NOTE: If the PAR-Q is being given to a person before he or she participates in a physical activity program or a fitness appraisal, this section may be used for legal or administrative purposes.

    "I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction."

  • Note: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes so that you would answer YES to any of the seven questions.

  • GYM - Agreement, Waiver & Release, Regulations



    Lockers are provided for daily use by members. Members must provide their own lock. Members are urged not to bring valuables into club premises. The club, its agents or employees shall not be liable for the loss, theft or damage to personal property of members and, or guests. Locks left overnight will be cut and items removed at member’s own expense.


    The membership card is not to be used by anyone other than the member to whom it is issued. Membership cards are required for admittance to the club. Members must show and scan their cards upon entering the club. Members who forget or misplace their membership cards may be charged a $2.00 admission fee to enter the club and asked to present photo ID. There will be a $19.95 + HST charge to replace any lost or stolen membership cards.


    The club will be available to members during club hours, unless otherwise specified on the agreement. The club may be temporarily closed for holidays and for periods of up to one week each year for maintenance purposes. Should the facilities be unavailable for use at any other time, due to damage by force majeure, catastrophe, accident or other reason beyond the control of the club, the membership term will be extended for a period of time equal the time of such unavailability.



    I acknowledge that the activity I am to undertake is a dangerous activity and that by participating in it I am exposed to certain risks. I acknowledge and understand that whilst participating in such activity:

    I may be injured, physically or mentally, or may die

    My personal property may be lost or damaged

    Other persons participating in such activity may cause me injury or may damage my property

    I may cause injury to other persons or damage their property

    The conditions in which the activity is conducted may vary without warning

    I may be injured or die or suffer damage to my property as a result of the negligence or breach of contract of Platinum Fitness & Supplements

    There may be no or inadequate facilities for treatment or transport of me if I am injured

    I assume the risk of and responsibility for any injury, death or property damage resulting from my participation in the activity


    Member hereby acknowledges all activities and programs performed at Platinum Fitness & Supplements shall be at his or her own risk and hereby releases and discharges Platinum Fitness & Supplements, its owner(s), officers, directors, agents, or employees from any liability, claims, demands, injury, damage, action, or cause of action whatsoever, which may result from the use of the services or facilities of Platinum Fitness & Supplements on the premises where the same or any and all acts of Platinum Fitness & Supplements, its officers, directors, agents, or employees may be rendered or carried out pursuant to this Agreement. IT IS THE INTENTION OF THE MEMBER BY THIS INSTRUMENT TO EXEMPT AND RELIEVE THE CLUB FROM ANY LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE.

    Member agrees that the club shall not be responsible or liable to member, or member’s guests for articles lost or stolen in the club. The club also shall not be responsible or liable for loss or damage to any property of member or member’s guests including automobiles and contents. It is agreed that any damage to the club facilities or property of member or member’s guests, by any other member is the sole responsibility of the offending member. Member acknowledges that he / she has read the foregoing three paragraphs, has been fully and completely advised of the potential dangers incidental to engaging in the Health Club Activities and is fully aware of the legal consequences of signing this instrument.


    Scan your membership card at the front desk prior to entering the club

    Members are not permitted to share their membership card

    Members may not solicit or conduct on the premises any personal training, with or without compensation. We retain sole discretion to determine whether a member is engaged in personal training

    No members are allowed behind the front desk.

    No street shoes or boots on workout areas, proper athletic footwear only

    Members must wear shirts (covering the chest and back) at all times in the club

    Ipods and earbuds are allowed, no boomboxes

    Gym bags are to be stored in a locker and are not permitted on the exercise floor

    The use of lockers is free and reserved for the time of your workout only; all locker content must be removed once you finish your workout

    We are not responsible for lost or stolen objects, please bring your own lock

    Spotters and collars are required for bench presses, incline and decline presses, and squats

    No use of chalk or dropping of weights.

    No littering or leaving debris on the gym floor

    Please be courteous and wipe down equipment after each use. Please do not spray directly on equipment. Spray on towel first then wipe equipment.

    Respect for all common areas is mandatory, return your plates and dumbbells to proper racks and help keep the workout area safe

    Aggressive behavior and / or foul language will not be tolerated under any circumstances

    No alcohol, smoking, or drugs allowed on the premises.

    Empty water bottles go in the recycling bins

    Cups, papers, and trash should be disposed of in the proper receptacles.

    Adjustment to the television, radio, heater, air condition, fans and other equipment may be made by staff only.

    Emergency doors are only to be used for emergencies

    Photos and/or videos of club may be taken and used for social media and advertising purposes

    I have read and agree with all of the above.

  • GYM / TRAINING - Parental Consent

    Required for all members under the age of 18.

    In consideration of participation in exercise activities, I agree, on behalf of the above named child, his/her heirs and representative, to fully and forever release, Platinum Fitness & Supplements, its officers, volunteers, agents and employees from any and all liability, claims, demands, damages, actions, of causes of action, whatsoever arising out of a or related to belonging to my child or me, related to the exercise activities, regardless of cause. This release covers everything that happens from the time my child arrives at Platinum Fitness & Supplements until he/she leaves.


    To the best of my knowledge, the above named child can fully participate in exercise activities. I am aware of the risks and hazards connected with exercise activities and my child hereby elects to voluntarily participate in the exercise activities, knowing that the exercises and equipment may be dangerous to my child. I voluntarily assume full responsibility for any risks of loss, property damage or personal injury that may be sustained by my child or any loss or damage to property owned by me or my child, as a result of being engaged in exercise activities at Platinum Fitness & Supplements, regardless of who caused the incident.


    It is my express intent that this release and hold harmless agreement shall bind the members of my family and spouse (if any), if I am alive, and my heirs assigned and personal representatives, if I am not alive, shall be deemed as a release, waiver, discharge and covenant not to sue Platinum Fitness & Supplements. I hereby further agree that this waiver of liability and hold harmless agreement shall be construed in accordance with the laws of the province of Ontario.


    I understand that Platinum Fitness & Supplements will not be responsible for any medical costs associated with any injury my child may sustain.


    My child and I further agree to become familiar with the regulations of Platinum Fitness & Supplements concerning participant conduct and not to violate said rules of any directive or instruction made by the person or persons in charge of the exercise facility.


    I have reviewed this Agreement and am aware of the risks involved in participating in the exercise activities and the possible injuries that may occur. My child freely and voluntarily agrees to participate in the exercise activities. In signing this release, I represent that I understand this Agreement and sign voluntarily as an act of my own free will. Platinum Fitness & Supplements has not made any oral representations, statements, or inducements, apart from this Agreement. I am at least eighteen (18) years of age and fully competent to execute this Agreement. Also, I understand that all rules and regulations for Platinum Fitness & Supplements will be enforced and any violation by my child may result in a call to me with a possible request to come and pick up my child.

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