Fitness Quest

Fitness Quest

Physical Activity Readiness Questionnaire (PAR-Q)
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.

Please complete this form honestly and to the best of your knowledge as it is an important part of the process to ensure the exercise you complete with Fitness Quest is safe and effective for you.

If you have any concerns about whether physical activity is suitable for you please get in touch to discuss.
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Email*
example@example.com
Phone Number*

Area CodePhone Number
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
If you answer YES or tick any boxes to any of the following questions, you should discuss your intentions to participate in an exercise programme with your GP before commencing.
Have you ever been diagnosed with any of the following medical conditions (tick all that apply)?

Heart diseaseHigh blood pressureAny other Cardiovascular problemsDiabetesAsthmaEpilepsy
Do you have any additional needs or any other medical conditions that may affect your participation in a fitness class? If yes please give details:*

YesNo
Please describe:
Are you prone to the following (tick all that apply)?

HeadachesFaintingDizziness
Have you ever suffered from any diagnosed or undiagnosed chest pain, particularly if associated with minimal effort? If yes please give details.*

YesNo
Please describe:
Do you ever suffer from pain or limited movement in any of the following (tick all that apply)?

Lower backNeckKneeHipElbowOther (please state)
Please state (if you answered other)
Do you suffer from any known allergies?*

Yes (please state)No
Please state (if you answered yes)
Have you given birth within the past 12 weeks?*

YesNo
If you have answered yes, please describe whether it was a natural birth or C-Section, how many weeks ago you gave birth and whether you have been given medical clearance to exercise.
Are you taking any medication?*

Yes (please state)No
Please state (if you answered yes)
Has your GP ever advised you NOT to exercise?*

YesNo
COVID-19 DECLARATION

I agree not to attend any Fitness Quest class should I develop any Covid-19 symptom or have been in close contact with anyone displaying symptoms or who has tested positive.

I will also not attend if I am awaiting the results of a Covid-19 test, regardless of symptoms or live with someone who is shielding or deemed as vulnerable.

I am happy to register for each class which will provide valuable track and trace information should it be required.

HEALTH AND FITNESS DECLARATION

I declare that I have answered the above questions correctly and to the best of my knowledge and I will follow the advice given to me by my instructor. Should my medical circumstances change I accept responsibility of keeping my instructor informed. By signing this form I confirm that I am medically fit and prepared to participate in a fitness programme and take full responsibility for my own health and safety during class (including carrying medication that may be required in an emergency), as well ensuring I will not endanger other class attendees.

PRIVACY

The information provided on this form is used to assess your current ability to participate in exercise and may also be used to prove non-disclosure, in the event any vital medical information has been withheld from this form.

Emergency contact information/home address (where virtual classes apply) will only be used in the event of a medical emergency and any medical conditions or injuries noted on this form may be passed to medical professionals should they be required to attend for your own safety.

Your information will not be sold, shared or passed on to any third parties. Your screening form will be stored securely and at your request may be viewed or destroyed. Screening forms are held for 12 months, at which time, if you are still an active participant you will be required to complete a new one. The Fitness Quest privacy policy can be found in full at: www.fitnessquest.co.uk
Please sign:*

Clear
Date*

DayMonthYear
Date
Should be Empty: