Physical Activity Fitness Questionnaire (PAR-Q)
This PAR-Q has been designed to help you help yourself. There are multiple benefits associated with regular exercise, however if you are planning on increasing the amount of physical activity in your life, then completion of this PAR-Q is required. For most people physical activity will not pose a problem or hazard, but completion of this will help identify the small number of people for whom physical activity might be unsuitable, or for those who should seek medical advise surrounding the type of activity most suited to them. If you are happy to continue, please click next.
PAR-Q
My doctor has indicated that I have heart condition, and should only take part physical activities recommended by them.
I feel pain in my chest when I carry out physical activities.
In the past month, I have had chest pain whilst NOT doing physical activities.
I have a bone of joint problem (E.G. Knee, Back or Hip) that could be made worse by a change in physical activity.
I am currently being prescribed drugs by my doctor for blood pressure or a heart condition (E.G Water pills).
I sometimes lose my balance due to dizziness.
I do, or have previously been known to loose consciousness.
I am currently recovering from a recent illness, operation OR injury.
I suffer, or have previously suffered with epilepsy. (Please Note - Flashing lights may be used during this class)
I know of another reason that would limit or restrict my participation in physical activity.
IMPORTANT
If you have selected ONE or more of the conditions listed in the previous question, then you will be required to obtain consent from your doctor and seek medical advise / approval before participating in the group exercise to music session. By selecting next, you confirm that you have either (A) Sought prior medical approval OR (B) confirm that you have read, understood and responded honestly.
Please enter any medical conditions that we should be aware of.
Class Booking Details
Please select the date of the class you would like to attend from the available options on the next card
Appointment
*
Email
example@example.com
Signature of Participant
*
Signature of Parent/Guardian
Submit
Should be Empty: