Day Pass Safety Form
To buy your Day Pass, you must complete this quick Physical Activity Readiness Questionnaire (PAR‑Q) first. It’s required for your health and safety while the gym is unstaffed. Once finished, you’ll receive an email with instructions on how to purchase your Day Pass.
Forename
Surname
Mobile Number
*
Please enter a valid mobile phone number
Format: 07000 000000.
Email
MUST BE ENTERED CORRECTLY
Date of Birth
*
-
Day
-
Month
Year
Has your doctor advised that you should not participate in physical activity or exercise?
*
Yes
No
Are you pregnant or post-natal?
*
Yes
No
Do you suffer from asthma or breathing difficulties?
*
Yes
No
Have you been in hospital in the last 3 years?
*
Yes
No
Are you taking any medication?
*
Yes
No
Do you suffer from diabetes or epilepsy?
*
Yes
No
Do you suffer from an allergy?
*
Yes
No
Has your doctor ever said that you have a heart condition and that you should only participate in physical activity recommended by a doctor?
*
Yes
No
Do you feel pain in your chest when you do physical activity?
*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?
*
Yes
No
Do you lose your balance because of dizziness, or do you ever lose consciousness?
*
Yes
No
Do you have a bone or joint problem that could be made worse by a change in your physical activity?
*
Yes
No
Is your doctor currently prescribing drugs (e.g., water pills) for your blood pressure or heart condition?
*
Yes
No
Do you know any other reason why you shouldn’t participate in physical activity?
*
Yes
No
Do you have gym experience and/or have you received an induction? If no, you will need an induction before you train in the gym.
*
Yes
No
If you answered YES to any of the above questions, please provide more information:
Height (cm)
*
Weight (kg)
*
Emergency contact name
*
Please enter as Forename and Surname
Emergency contact number
*
Please enter a valid phone number
Format: 00000 000000.
Submit
Should be Empty: