Physical Activity Readiness Questionnaire (PAR-Q)

Note: Please fill this form in before your first class (if anything changes between or before the clast please let me know).

This PAR-Q is designed to help you to help yourself. Many benefits are associated with regular exercise, and completion of the PAR-Q form is a sensible first step to take if you are planning to increase the amount of physical activity in your life.

For most people physical activity should not pose a problem or hazard.

The PAR-Q has been designed to identify the small number of people for whom physical activity might be inappropriate or for those who should seek medical advice concerning the type of activity most suitable for them. Common sense is your best guide for answering these questions.

If you have answered YES to any of the below questions, then you are required to gain consent from your doctor before participating in a fitness class.

Name

Age

Emergency Contact Name

Emergency Contact Number

Have you booked in and paid (just checking, I'm rubbish at admin:)

Yes

If someone booked for you - what's their name?

___________________________

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Yes

Do you feel pain in your chest when you perform physical activity?

Yes

In the past month, have you had chest pain when you were not performing any physical activity?

Yes

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

Yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

Yes

Do you know of any other reason why you should not engage in physical activity?

Yes

Our Privacy Policy applies.

Note: Please fill out the fields marked with an asterisk.

You are advised to postpone entry into any training program if you feel unwell or have a temporary illness. You must inform your instructor of any changes to your health status whiles engaged in your training programme.

Thank you for taking the time to fill out this form. I look forward to seeing you at my Yoga Class.

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