PARQ

  • Pre-Activity Readiness Questionnaire (PAR-Q)

    For Chakra Dancing Classes and Workshops on behalf of Erica Ferrar Healing.

  • Please note that all information given in this form is confidential and can only be accessed and used by Erica Ferrar of Erica Ferrar Healing. This information is used to determine the safety of all participants only.

    As a registered member of the ICO, the information will be stored and later destroyed after a determined amount of time in accordance with ICO regulations.

  • Your Details

  • Date of Birth*
     - -
  • Format: 00000000000.

  • Health Questions

  • Has your Doctor ever said you have a heart condition?*
  • Do you have pains in your chest whilst performing physical activity?*
  • Have you had chest pain while not doing physical activity?*
  • Do you lose yoour balance due to dizziness or ever lose consciousness?*
  • Do you suffer from high or low blood pressure?*
  • Have you had surgery recently?*
  • Do you have any chronic illnesses or physical limitations?*
  • Do you have any injuries, bone/joint or orthopedic problems (such as back, shoulder, knee etc) that affect your ability to exercise?*
  • Do you take any medication (prescription or non-prescription) that affects your ability to exercise?*
  • Do you know of any other factor which may affect your ability to participate in physical activity?*

  • If you have answered YES to any of the above questions and you are not sure whether you should attend, then please do contact your GP for clarification before attending.

    If in doubt, please contact Erica Ferrar at info@ericaferrarhealing.co.uk

     

  • I confirm that I have completed the form to best of my understanding. If I am in doubt, I will contact my GP for clarification of my fitness to attend. I will withdraw if my GP recommends that I am not fit enough to attend this class.

    I hereby waive Erica Ferrar at Erica Ferrar Healing from liabilities or demands as a result of injury, loss or adverse health conditions as a result of my participation.

    I confirm that I have read this form fully and am happy to attend the classes.

     

  • Should be Empty: