Par-Q Form

Full Name*

Date Of Birth*

Email*

Phone/Mobile*

Address*

I am attending the following classes:

Emergency Contact Full Name*

Relationship To You*

Emergency Contact Phone/Mobile*

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.

YES/ NO*

	Yes	No
Has your doctor ever said that you have a heart condition (had a stroke, heart attack, or heart surgery) and/ or that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Have you ever been told by a doctor that you have bone, joint, or muscle problems that could be made worse by physical activity?
Do you have any breathing difficulties?
Do you have a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Are you pregnant now or have given birth within the last 6 months?
Have you had a recent surgery?
Are you currently on any medications, either prescription or non-prescription, on a regular basis?
Do you have any allergies?
Do you know of any other reason why you should not do physical activity?

If you have answered 'Yes' to any of the above, please elaborate below:

Are you happy to be contacted by email?*

YesNo

Are you happy to be contacted by WhatsApp?*

YesNo

Occasionally, photos and videos are taken during class. Are you happy for any that you are in to be used on social media?*

YesNo

Yor Data*

By providing your personal data, you acknowledge that Claire's Rhythm & Moves will process your information in accordance with the General Data Protection Regulation (GDPR) and our Privacy Policy, which outlines how we collect, use, store, and protect your data. You have the right to access, rectify, erase, restrict, and object to the processing of your personal data; please contact us at claire.fitx@gmail.com to exercise these rights.

Fitness Participation Agreement

I have answered the questions above to the best of my ability and affirm that my physical condition is good and I have no known conditions that would prevent me from participation.

I acknowledge that participation is at my own pace and comfort level and that I may discontinue my participation in the sessions at any time.

I understand that if I have answered 'YES' to one or more of the above questions, I should seek medical advice before undertaking any new physical activity.

Furthermore, I agree to self-determine my exertion through good judgement and to discontinue any activity that exceeds my personal limitations.

I understand that by signing this agreement that I hereby waive and release Claire's Rhythm & Moves, in any way from liabilities or demands as a result of injury, loss, or adverse health conditions as a result of my participation. I affirm that I have read and understand this document and I wish to participate in fitness activities.

>Please ensure that any medication that may be needed is carried with you and the instructor is notified.

Date*

Date

Please put your initials here so as to sign the document*

Physical Activity Readiness Questionnaire (PARQ)

Yor Details

Emergency Contact Details

THANK YOU!