PAR-Q 9 Physical Activity Readiness Questionnaire PAR-Q Form Personal DetailsFull NameDate of BirthEmail AddressPhone NumberAddressAddress Line 1Address Line 2TownCountyPostcodeIf you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you significantly change you physical activity patterns. If you are over 69 years of age and are not used to being very active, please check with your doctor. Please read the following carefully and answer honestly by ticking the box to indicate YES.Please SelectBone or joint problems, such as arthritisHigh Blood PressureLow Blood PressureDiabetes Mellitus or any other metabolic diseaseRaised cholesterolHeart conditionEver felt pain in your chest when you do physical exerciseAre you currently taking any medicationEver suffered from unusual shortness of breath at rest or with mild exertionA history of coronary heart disease in your familyFeel faint, dizzy or have lost consciousnessPossibility that you might be pregnantDo you know of any other reason why you should not participate in a physical activity programmeNone of the aboveIf you answered YES to any of the questions above please give more details: I hereby state that I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury. AgreePrint Full NameTodays Date Note: This PAR Q becomes invalid if your condition changes so that you would answer YES to any of the questions.Emergency Contact Name, Address & Contact NumberHave you had Covid 19? Yes NoIf so when?Have you had the Covid 19 Vaccine? Yes NoIf so when?If you said yes to having had coves 19. Have you experienced what you would consider to be any signs or symptoms of long-Covid?If not, have you noticed any changes to your normal level of energy, physical activity or exercise that has been altered or seems to be worsened since your exposure to the virus? DATA DISCLAIMER: Please read and then tick the box to give consent to your data being processed The data hereby collected will remain solely in the hands of unit1 and will not be share to any third parties. It is used for the purpose of health monitoring and in the event of an incident contacting your nominated emergency contact. We may also at times require to contact you to advise of class changes or cancellations and/or related classes. It will be kept on our records for 1 year. Unit1 Fitness Terms and conditions Please do not attend class if you have any symptoms of Corona virus including high temperature or persistent cough. All classes must be booked and paid for in advanced. All bookings are non-refundable and non-transferable. Participants temperature will be taken on entering the building and we reserve the right to refuse entry if your temperature is high. All participants must arrive on time for the class, the instructor reserves to right to refuse entry to late arrivals. Class members must bring their own bag gloves to use for boxercise classes and Ten3s sessions. Exercise mats should be brought for all fitness classes (except for Trampoline fitness classes). If you are unable to attend a class please cancel your booking so that we can allocate to space to another member as some classes have a waiting list. I hereby state that I have read, understood and accept the above terms and conditions. AgreePrint Full NameTodays DateSubmit Form
