Physical Activity Readiness Questionnaire (PARQ)
Vikki Baynes
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Which class have you booked onto?
*
Sweaty Mama
Strength
Mamalates
Bootcamp
Your Childs name/age
*
Emergency Contact details
*
First Name
Last Name
Emergency Contact number
*
-
Area Code
Phone Number
Our Classes
All classes have been specifically designed to aid recovery post-natally and support rebuilding your fitness levels gradually. Classes are focused around low impact options and rebuilding core & pelvic floor strength, and may include cardio work along with strength and conditioning exercises. The intensity of exercises can be increased or decreased in every session to give the best results dependent on your individual circumstances.
Potential Risks
Please note that all physical activity carries risks. The reaction of your body's systems to exercise cannot always be predicted with accuracy. Abnormal changes occurring during or following exercise may include abnormalities of blood pressure or heart attacks. Some activities include the option to incorporate babywearing or holding/carrying your child. If you choose not to babywear or hold your child during exercise, you may be given optional weights to use instead. The lifting or carrying of your child or weights, and engaging in physical activity during classes may lead to musculoskeletal strains, pain and injury if adequate warm-up, gradual progression, and safety procedures are not followed.
Potential Benefits
A programme of regular exercise has many mental and physical health benefits associated with it. Our classes also offer a valuable bonding opportunity with your child. However, results will vary between individuals and we cannot guarantee any particular outcome as a result of participating in our classes.
Participating in our classes
You are responsible for participating in a safe and responsible manner in the classes, including carefully following any instructions given, not performing any activities which you do not feel comfortable with and asking for advice if you have any concerns. You must withdraw from the class immediately if you feel unwell or feel any pain or discomfort which causes you any concern. If you have any concerns about your health, you should speak to your doctor and follow any advice given, including advice as to whether to participate in a class and whether or not to undertake any particular activity. If you do participate in a class, you should also bring any health concerns to the instructor’s attention, as well as any other issues which may be relevant to your participation in the session, particularly if you are pregnant or have recently given birth. Where we provide exercise equipment, you should not use this unless you are fully familiar and comfortable with its proper use and you will be fully responsible for any injury or damage caused by your use of the equipment. Neither Sweaty Mama Limited, the franchisee or the instructor can be held responsible for any injury which you sustain whilst participating in a class, unless it can be shown that the injury was caused by their negligence.
Photography
We occasionally share photographs of our classes on our website and social media pages, so it’s possible at times we may take pictures/video clips during the classes. We will never allow anybody else to use these photographs and we’ll never use inappropriate or unflattering images of you. We hope that this isn’t a problem, but if you are at all concerned about either pictures of yourself or your child being used online just let your instructor know.
I have read the foregoing information and understand it. Any questions which may have occurred to me have been answered to my satisfaction.
*
Yes
Your ParQ
This PARQ is designed to help you help yourself. Many health benefits are associated with regular exercise, and the completion of the PAR-Q 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 those who should take medical advice concerning the type of activity most suitable for them. Please read the following questions carefully and select the response that best applies to you.
Have you been diagnosed with a heart condition and advised only to do 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/joint problem (e.g. back, knee or hip) that could worsen 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 conditions?
*
Yes
No
Do you know of any other reason why you should not do physical activity?
*
Yes
No
Please provide more information if you answered YES to any of the questions above.
*
About your Birth
Please provide as much information as you feel relevant
Have you experienced any complications during pregnancy/birth or post-partum?
*
Yes
No
Other
What type of delivery did you have?
*
Vaginal
Assisted Vaginal
C-Section (Planned)
Emergency C-Section
Did you tear or require an episiotomy?
*
Yes
No
Have you had any of the following since giving birth:
*
GP 6 Week Check up
Mummy MOT/Pelvic Health Physio
NHS physio referral
Other
None of the above
Have you experienced any of the following symptoms since giving birth:
*
Pelvic Floor Heaviness/Feeling of bulging
Urinary Incontinence
Faecal Incontinence
Pelvic pain
Diastasis Recti
Hip Pain
Back Pain
Wrist Pain
Knee Pain
None of the above
Are you continuing to receive ongoing care from any of the following health professionals:
*
Midwife
GP
Private Physio
NHS Physio
None of the above
Other
Is there anything else that you would like to make me aware of before your first class, or any concerns or questions that you would like to have a chat about?
*
I confirm that I have read, understood and completed this questionnaire to the best of my knowledge. Any questions I may have had have been answered to my full satisfaction. I confirm that I am aware of and understand the T.I.C.K.S Rules for Safe Baby wearing. I acknowledge that it is my responsibility to read and follow the manufacturers guidelines for my sling/carrier, and that I need to ensure it is safe for use for my child.
*
Yes
Signature
Submit
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