BG PT Boot Camp PARQ

BG PT PARQ

Physical Activity Readiness Questionnaire (To be completed before Bootcamp, Total Body Tone or Mama Moves fitness classes)
Name

First NameLast Name
Email
example@example.com
Address

House name / number

Street

Town County

Postcode
Phone Number
Please enter a valid phone number
Do you have or have you ever been told that you have a heart condition?
Have you ever had a stroke?
Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity?
Do you ever feel faint, dizzy or lose balance during physical activity?
Do you have asthma? If so, have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?
Do you have diabetes?
If you have diabetes (type 1 or 2) have you had trouble controlling your blood sugar (glucose) in the last 3 months?
Do you have any other medical conditions or any disability that may require special consideration for exercise?
Do you have any muscle, bone, tendon or joint problems at all that affect your ability to participate in physical activity?
If 'Yes' to any of the above please provide details below...
'No' to all questions - You can be reasonably sure that it is safe for you to participate in physical activity, gradually building up from your current ability level, I look forward to seeing you at the bootcamps to help you do this.

'Yes' to one or more questions- Please consult your doctor before begining physical activity

If you are unsure please feel free to contact me Becca 07770286644 / BG-PT@outlook.com and we can discuss it together.
Emergency contact -
Name:
Relationship to you:
Contact number:
Informed consent
- To the best of my knowledge that all of the information I have provided on this pre exercise screening questionnaire is accurate.
- In the case that my medical or health condition changes over the course of my fitness training I will inform Becca, at Becca Graham Personal Training at the earliest convenience and update my details with a new pre exercise screening questionnaire.
- Whilst I am aware every care will be taken at the bootcamps, I acknowledge I will be participating at my own risk.
Signed…
Date

MonthDayYear
Date
Your personal information will only be stored for medical/insurance compliance by Becca Graham Personal Training
Should be Empty:

BG PT PARQ