Physical Activity Readiness Questionnaire (PAR-Q)

Prior to participating in our fitness classes, you are required to complete this Physical Activity Readiness Questionnaire

For most people, physical activity should not pose any problem or hazard, however, potential risks, whilst not apparent at rest, may be exacerbated by an increase in levels of physical activity. The PAR-Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who should seek medical advice concerning the type of activity most suitable for them.

Please complete the questionnaire below by reading each question carefully and ticking the response that applies to you. You are wholly responsible for your answers and if you are in any doubt you must seek medical advice.

Are you taking any prescribed medication?

Has your doctor ever said that you have a bone or joint problem, such as arthritis, or any medical condition, surgical operation or injury that has been aggravated by exercise or might be made worse with exercise?

Do you have high blood pressure?

Do you have low blood pressure?

Do you have Diabetes Mellitus or any other metabolic disease?

Has your doctor ever said you have raised cholesterol (serum level above 6.2mmol/L)?

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

Have you ever felt pain in your chest when you do physical exercise or at rest?

Is your doctor currently prescribing you drugs or medication?

Have you ever suffered from unusual shortness of breath at rest or with mild exertion?

Is there any history of coronary heart disease in your family?

Do you often feel faint, have spells of severe dizziness or have you ever lost consciousness?

Do you currently drink more than the average amount of alcohol per week (21 units for men and 14 units for women)?

Do you suffer from regular headaches, dizziness, fainting or fits?

Do you currently exercise on a regular basis (at least 3 times a week) and/or work in a job that is physically

Are you, or is there any possibility that you might be pregnant?

Do you know of any other reason why you should not participate in a programme of physical activity?

Is there any further information you feel the instructor should be aware of?

Laura’s Health & Dance Fitness

Physical Activity Readiness Questionnaire (PAR-Q) cont.

You must consult your doctor before undertaking any fitness classes. You will need to discuss the nature of the activity you are about to undertake and either present your PAR-Q or tell your doctor which questions you answered ‘yes’ to. Your doctor needs to advise you as to your suitability for unrestricted physical activity.

If you answered ‘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.

By signing this PAR-Q I undertake that I have read, understood and correctly answered the questions set out above. I wish to participate in activities that may include aerobic, anaerobic, flexibility, stability, resistance, muscular strength and endurance exercise. I realise that my participation in these activities involves the risk of injury and even the possibility of death. 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 signing this form I am also confirming that I have taken medical advice relating to my participation and my doctor has confirmed I am fit enough to participate.

All exercises and routines are designed to enable learners to experience different level of intensity and duration of activities. As a result, some individuals may experience different feelings of load in their muscles and varying breathing patterns. Each routine is designed to be safe and effective and to minimise any risk of injury.

During exercises we use equipment for example maracas in our dance class, please be aware of the people around you when using these maracas as Laura’s Health and dance fitness or members of our team cannot be held responsible for any damage to persons or property as a result of their use.

If you feel any pain or discomfort at any time, you should stop doing the activity concerned immediately and tell your Instructor. If you have any reason that you believe means that you should not perform any of the activities you are asked to do, please do not perform that activity.

If you are taking part in any ONLINE classes or routines via social media or video streaming platforms, you must ensure that you wear the appropriate footwear for the floor surface where you are dancing/ working out, and ensure you have sufficient room to move around. Please also ensure the room is at an appropriate temperature with sufficient ventilation and you drink plenty of water throughout.

Laura’s health and dance fitness takes no responsibility for any injuries, damages or accidents that may be sustained during the online participation of our classes in your home/workplace environment.

For your information: By signing this form you are giving us permission to contact you in accordance with the new data protection law (GDPR Compliance) May 2018.

We take data protection very seriously and all data will be securely kept as per the recommendations and legislations set out by the GDPR, the ICO and data protection laws.

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Laura’s Health & Dance Fitness