PARQ - ALL CLASSES

Circuit Training with Sharon Brown Fitness Registration & Health Check

You must complete and submit a Physical Activity Readiness Questionnaire before attending your first Circuit Training session.

Physical Activity Readiness Questionnaire (PAR-Q)

* Indicates required field

Name *

First

Last

Phone Number *

Email *

Emergency Contact Name & Number *

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

2. Do you feel pain in your chest when you do physical activity *

3. In the past month, have you had chest pain when you were not doing physical activity? *

4. Do you lose your balance because of dizziness or do you ever lose consciousness? *

5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in physical activity? *

6. Is your doctor currently prescribing drugs (for example water pills) for your blood pressure or heart condition? *

7. Do you know of any other reason why you should not do physical activity? *

If you have answered YES to question 7 please give details *

If you have answered:
'YES’ to one or more question:
You are required to gain consent from your doctor before participating in Circuit Training
‘NO’ to all questions:
You acknowledge that you are taking responsibility for the accuracy of your replies and the decision that you are physically fit enough for unrestricted physical activity.

DECLARATION

I undertake that I have read, understood and correctly answered the questions set out above.
I wish to participate in Circuit Training and I understand that my participation in this class involves the risk of injury.
I confirm I am voluntarily engaging in a level of exercise that I consider acceptable and appropriate to my level of fitness.
If I have answered ‘YES’ to any of the questions above, by submitting this form I am also confirming that I have taken medical advice relating to my participation and my doctor has confirmed that I am fit enough to participate.

SUBMIT

Circuit Training with Sharon Brown Fitness Registration & Health CheckYou must complete and submit a Physical Activity Readiness Questionnaire before attending your first Circuit Training session.

Circuit Training with Sharon Brown Fitness Registration & Health Check

You must complete and submit a Physical Activity Readiness Questionnaire before attending your first Circuit Training session.