ParQ_Screening

Full Name

First NameLast Name

Email

example@example.com

Date of Birth

DayMonthYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Sex

Phone Number

Emergency Contact

NameMobile

Has your doctor ever said you have a heart condition or high blood pressure?

Do you experience chest pain during physical activity?

Do you lose balance because of dizziness or have you lost consciousness recently?

Do you have any bone, joint, or muscle problems that could be worsened by exercise?

Are you currently taking prescribed medication for a medical condition?

Are you pregnant or have you given birth within the last 6 months?

Have you ever been advised by a healthcare professional to avoid certain types of physical activity for physical or mental health reasons?

Are you currently experiencing any mental health condition, stress, anxiety, depression, panic attacks, or other emotional wellbeing concerns that may affect your participation in exercise or group activities?

Do you have any other medical condition or injury that may affect your ability to exercise safely?

Please provide details for any questions answered YES above, or any relevant medical or wellbeing information:

I consent to photographs and/or videos being taken during sessions for use on social media, websites and other promotional materials.

Please select which class/classes will you be attending?

On average, how many times a week to you participate in physical activity?

	1	2	3	4	5

1 is , 5 is

Participant Declaration.

I confirm that the information provided on this form is accurate to the best of my knowledge. I understand that participation in fitness classes, wellbeing activities, and online fitness sessions involves physical exertion and carries some risk of injury or emotional discomfort. I agree to take part voluntarily and will inform the instructor of any changes to my physical or mental health.I understand that if I have answered YES to any of the questions above, I may be advised to seek medical or professional guidance before participating.

By submitting your form, you are agreeing to the above terms & conditions.

Par Q