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The Bowflex Blaze Home Gym Owner’s Manual and Fitness Guide
Your Bowflex® Blaze™ home gym has a number of seat and bench positions: flat bench forward, flat bench back, 45° incline and free-sliding seat extension To adjust the seat, pull out the Seat Rail Knob, then slide the seat to one of the three locking holes on the Seat Rail Release the Seat Rail Knob to secure when finished
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Planning Clermont Début 02/09/2020 - Beoforme
Salle du bas : 10 pers max Lundi Mardi Mercredi Jeudi Vendredi Samedi 9h-9h50 Pilates Tonique Maelan 10h15-11h05 Gym Degasquet Abdos/Cuisse/Gainage Anne Solene 10h-10h50 Degasquet Santé Anne Solene 9h-9h50 Pilates bosu Benoit 9h-9h50 Gym Degasquet Abdos/Dos/Périné Anne Solene 9h30-10h15 Bébés gym :18m-3A Valérie/Sandra 10h15-11h05 Renfo
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PREPARTICIPATION PHYSICAL EVALUATION -- MEDICAL HISTORY Thi
s MEDICAL HISTORY FORM must be completed annually by parent (or guardian) and student in order for the student to participate in activities. These
question s are designe d to dete rmine if the student has develope d any condition which would make it hazardous to participate in an event.Student's Name: (print)
Sex Age Date of Birth
Address Phone
Grade SchoolPersonal Physician Phone
In case of emergency, contact:
Nam e Relationship Phone (H) (W)If, in the judgment of any representative of the school, the above student should need immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and
consent to such care and treatment as may be given said student by any physician, athletic trainer, nurse or school representative. I do hereby agree to indemnify and save harmless the
schoo l and an y school or hospital rep resentative from any claim by any person on account of such care and treatment of said student.If, between thi
s date an d the beginning of , any illness or injury should occur that may limit this student's participation, I agree to notify the school authorities of such illness or
inju ry. I hereb y state that, to the best of my knowledge, my answers to the above questions are complete and correct. Failure to provide truthful responses could
sub ject the student in question to penalties determined by the UILStudent
Signature:
Parent/Guardian Signature:
Date: Any Yes answer to questions 1, 2, 3, 4, 5, or6 requires further medical evaluation which may include a physical examination. Written clearance from a physician,
physician assistant, chiropractor, or nurse practitioner is require d before any participati on i n UIL practices, games or matches. THIS FORM MUST BE ON FILE PRIOR TOPARTICIPATION IN
AN Y PRACTICE, SCRIMMAGER CONTEST BEFORE, DURING OR AFTER SCHOOL.For School Use Only:
This Medical History Form was reviewed by: Printed Name Date Signature 1. Yes o No o 13. Yes o No o2. o o o o
o o o o 3. o o 14. o o o o o o o o 15. o o o o o o o o o o o o o o Have you ever gotten unexpectedly short of breath with exe rcise? Do yo u hav e asthma Do yo u hav e seasonal allergies that require medical treatment? Do yo u us e an y specia l protective or corrective equipment or device s tha t aren't usually used for your or positio n (fo r example , knee brace, special neck roll, foot orthotics, retainer on your t eeth, heari ng aid)?Have you ever had a sprai
n strain, or swelling after injury?Have yo
u broken or fractured any bones or dislocated anyjoints? Have you had any other problems with pain or swelling in muscle s, tendons, bones, or joints?If yes
check appropriate b ox and explain below: o o o Head o Elbow o Hip oo o Necko Forearmo Thigh o Backo Wristo Knee o Chesto Hando Shin/Calf o o o Shoulder o Finger o Ankle o Upper Arm o Foot o o 16.17. Do you want to weig more or less than you do
Do you feel stressed out? o o o o 4. 4 o o 18.Have you ever been diagnosed with or treated for sickle cell o o o o trait or cell disease?Females
19. When was your first menstrual period? _____________
o o o o o o o o When was your most recent menstrual period? _____________How much time do you usually
have from the start of one period to the start of another? _____________ How many periods have you had in the last year? _____________ What was the longest time be tween periods in the last year? _____________Have you had a medical illness or injury since your last check up or p hysical Have you been hospitalized overnight in the past year?Have you ever had surger
y? Have you eve r had prior testing for the heart ordered by a physician?Have you ever passed out during or after exerci
seHave you ever had chest pain during or after ex
e rcise?Do you get tired more quickly than your
friends do during exe rcise? Have you ever had racing of your heart or skipped heartbeats?Have you had hig
h blood pressure or high cholesterol?Have you ever been told you have a heart murmur?
Has any family member or relat
ive died of heart problems or of sudde n unexpected death before age 50? Has any family memb er been diagnosed with enlarged heart, (dilated cardiomyopathy), hypertrophic cardiomyopathy, long QT sy ndrome or other ion channelpathy (Brugada syndrome, etc),Marfan's
syndrome, or abnormal heart rhythm? Have you had a severe viral infection (for example, myoca rditis or mononucleosis) withi n the last month? Ha s a physician ever denied or restricted your participation in for any hea rt problems?Have you ever had a head inj
ury or concussion?Have you ever been knoc
ke d out, become unconscious, or lost your memory?If yes
ho w man y times? __________ When was your last conc ussion? __________How severe was each one? (Explain below)
Have you ever had a seizure?
Do yo u have frequent or severe hea dachesHave yo
u ever had numbness or tingling in your arms, hands, legs or fee t?Have yo
u ever had a stinger, burner, or pinched nerve? o o5.Are you missing any paired organs?
o o6.Are you under a doctor's care?
o o 7. Are you currently taking any prescription or non-prescription (over-the-counter) medication or pills or using an inhaler? o o8.Do you have any allergies (for example, to pollen, medicine,
food, or stinging insects)? o o9.Have you ever been dizzy during or after exercise?
o o10. Do you have any current skin problems (for example, itching,rashes, acne, warts, fungus, or blisters)?
o o11. Have you ever become ill from exercising in the heat?
o o12. Have you had any problems with your eyes or vision?
o o Explain "Yes" answers in the box below**. Circle questions you don't know the answers to. 'R\RXKDYHWZRWHVWLFOHV" _____________ REWDLQDQ(&*IRUP\VWXGHQWIRUDGGLWLRQDO
LymphHeart-Auscultation of the heart
the supineHeart-Auscultation of the heart
the standingHeart-Lower extremity
Genitalia (males
Marfan's stigmata
pectus excavatum, hyp ermobility, PREPARTICIPATION PHYSICAL EVALUATION -- PHYSICAL EXAMINATIONStudent's Name _________________________________ Sex _______ Age _______ D ate of Birth _________________________
Height ______ Weight________ % Body fat (optional) ________ Pulse __________ BP____/____ (____/____, ____/____)
brachial blood pressure while sittingVision: R 20/______ L 20/___ Corrected: o Y o N Pupils: o Equal o Unequal As a minim um requirement, this Physical Examination Form must be co mpleted prior to ju nior highparticipation and again
prior to first and thi rd years of high school participation. It must be completed if there are yes answe rs to specific questions on
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