PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

PHYSICAL ACTIVITY READINESS QUESTIONNAIRE

(PAR-Q)
Name
Gender
Email address
example@example.com
Age
Contact number
Next of kin's name
Emergency Contact number
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.

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in physical activity?
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition? YES/NO
7. Do you know of any other reason why you should not do physical activity?
If you have answered YES to any of the above questions, then you are required to gain consent from your doctor before participating in the group exercise to music session.

Delay becoming more active if:
- You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
- You are pregnant - talk to your health care practitioner, your physician, a qualified exercise professional, before becoming more physically active.
- Your health changes talk to your doctor or qualified exercise professional before continuing with any physical activity program.
suitability for exercise, sign the participant declaration below.

If you have answered NO to all the above questions and you have reasonable assurance of your suitability for exercise, sign the participant declaration below.
- It is advised that you consult a qualified exercise professional to help you develop a safe and effective physical activity plan to meet your health needs.
- You are encouraged to start slowly and build up gradually 20 to 60 minutes of low to moderate intensity exercise, 3-5 days per week including aerobic and muscle strengthening exercises.
- If you are over the age of 45 years and NOT accustomed to regular vigorous to maximal sort exercise, consult a qualified exercise professional before engaging in this intensity of exercise.

All persons who have completed the PAR-Q+ please read and sign the declaration below. If you are less than the legal age required for consent or require the assent of a care provider, your parent/guardian or care provider must also sign this form.

Please note that no liability is accepted for any loss of or damage to any articles, which you may bring with you to classes. Equally, liability is not accepted for loss of or damage to motor vehicles or their contents and these are left at the owner's risk.

Iconfirm that where any medical condition, discomfort or injury which may be affected by physical activity applies or becomes applicable at any time when I am participating in a class, I am responsible for checking with my doctor to ensure I am able to participate in this activity.
Print Name
Date

MonthDayYear
Date
Signature
Date

MonthDayYear
Date
Parent/Guardian/Care Provider Signature
Date

MonthDayYear
Date
I would like to collect and use your personal data to keep you updated about my group exercise classes and to keep me informed about any health or wider needs you have that I need to consider whilst delivering your class/es. See Participant privacy notice.

Please tick if you are happy for me to collect and store your personal data.

Participants Privacy Notice - Encompass Fitness Ltd

As your group exercise instructor, I am committed to protecting your privacy. This privacy policy sets out how I use and protect any information that you give me.

Your personal data and your membership/attendance

As an attendee of my group exercise classes, I collect, store and use the personal data that you provide me. I do this so that I can effectively manage my classes and ensure that as a participant you are kept informed and safe. I may use your data to contact you with class updates and wider group exercise related opportunities I think you may be interested in. I will use your data to keep me informed about any health or wider needs you have that I need to consider whilst delivering your class/es. If you have provided me with emergency contact details I will use this data when required. Some of the data that I collect from you is "specialist category'. This includes (not exhaustively) any data relating to disabilities and health. I collect and use this data to enable me to tailor activities to your needs.

Unless you have given me separate written consent, I will cease to contact you 6 months after your stop attending my class/es. At this point I will also delete/destroy all personal data that is not linked to financial records. I will store any personal data linked to financial records for a 6-year period. HM Revenue and Customs (HMRC) have the right to inspect financial information relating to the previous 6 years and require all trading entities to keep financial records for this length of time.

I will not share your personal data. All data you provide to me is stored on a password protected device and/or locked away.

You may request details of personal data which I hold about you or withdraw your consent at any time. You can contact me on 07752 216580 or encompassfitness@outlook.com. If you have any concerns about my information rights practices, you can raise them here www.ico.org.uk/concerns or by calling 03031231113.
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