Move Strong PARQ

Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Emergency Contact Number

Area CodePhone Number

Emergency Contact Name

First NameLast Name

By taking part you consent to photos and videos being taken whilst the group session is taking place. The photos will not be close ups of individuals but showing the group as a whole. Do you understand?

How did you hear about us?

Do you have any joint issues that could be aggravated by exercise?

Do you have high or low blood pressure?

Do you have Diabetes Mellitus or any other metabolic disease?

Do you have high cholesterol?

Do you have a heart condition?

Are you currently taking any prescribed medication?

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

How often do you exercise?

Are you or is there a possibility you could be pregnant?

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

If you answered Yes to any question, please give more information here.

If you have not recently done so, consult your doctor by telephone or in person before increasing your physical activity and/or taking a fitness appraisal. I hereby state that I have read, understood and answered honestly the questions above. I also state that I wish to participate in activities, which may include aerobic exercise, resistance exercise and stretching. I realise that my participation in these activities involves the risk of injury and even the possibility of death. Furthermore, I hereby confirm that I am voluntarily engaging in an acceptable level of exercise, which has been recommended to me.

By SUBMITTING this form, you confirm you have read the above, answered all questions honestly and correctly and confirm to your knowledge you feel you are in good health to attend your class. If your health changes at any time within your class it is your responsibility to notify a member of Move Strong.

Form

Physical Activity Readiness Questionnaire