SW Cali Meet-Up Emergency Contact & PAR-Q Form

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Area Code

Phone Number

3

Email* This field is required.

example@example.com

4

Where in the South West are you located? (Enter first part of postcode):* This field is required.

5

Name* This field is required.

First Name

Last Name

6

Phone Number* This field is required.

Area Code

Phone Number

7

Relationship to you:

8

Has your doctor ever said you have a heart condition or should only do physical activity recommended by a doctor?* This field is required.

YESNO

9

Do you ever feel pain in your chest when performing physical activity?* This field is required.

YESNO

10

Do you ever experience chest pain when you are not physically active?e a question* This field is required.

YESNO

11

Do you lose balance because of dizziness or ever lose consciousness?* This field is required.

YESNO

12

Do you have a bone, joint, or back problem that could be made worse by exercise (e.g. wrist, shoulder, neck, or spine)?* This field is required.

YESNO

13

Are you currently taking any medication that may affect your ability to exercise safely?* This field is required.

YESNO

14

Are you pregnant, or have you given birth in the last 6 months?* This field is required.

YESNO

15

Do you know of any other reason why you should not take part in physical activity?* This field is required.

YESNO

16

If you answered YES to any question, please give details below:

17

I acknowledge that participation in SW Cali Meet-Ups and Skills Workshops carries inherent risks, and I accept responsibility for my own safety.* This field is required.

YESNO

18

I acknowledge that the organisers, volunteers, and gym staff bear no liability for any injury, loss, or damage, except in instances of gross negligence.* This field is required.

YESNO

19

I give permission for SW Cali to take photos and videos of me during meet-ups, workshops, or training sessions. I understand that these may be used for social media, WhatsApp groups, or marketing purposes, and I can withdraw my consent at any time.* This field is required.

YESNO

20

If you’re on social media, what’s your Instagram username?

21

Date* This field is required.

Date