THEA HUDSON FITNESS

Many health benefits are associated with regular exercise, and the completion of 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 any problem or hazard. PAR-Q is designed to identify the small number of adults for whom physical activity might be inappropriate or those who should have medical advice concerning the type of activity most suitable for them. Common sense is the best guide in answering these few questions.

First Name*

Surname*

D.O.B*

Date

Email*

example@example.com

Mobile*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Next of Kin*

First NameLast Name

Mobile *

Area CodePhone Number

Please give details of any injuries:

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 a diagnosed illness that could be made worse by physical activity?
Is your doctor currently prescribing medication for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

If you answered:

‘Yes’ to one or more questions:

You must consult your doctor before undertaking any fitness appraisal, workshop or other exercise routine. You will need to discuss the nature of the activity you are about to undertake and either present your PAR-Q or tell your doctor which questions you answered ‘yes’ to. Your doctor needs to advise you as to your suitability for unrestricted physical activity.

‘No’ to all questions:

You acknowledge that you are taking responsibility for the accuracy of your replies and the decision that you are physically fit enough for unrestricted physical activity.

You are advised to postpone entry into the class if you feel unwell or have a temporary illness. You must inform your personal trainer of any changes to your health status, whilst engaged in your training programme.

Fitness Participation Agreement

I have voluntarily chosen to participate in planned activities offered by Thea Hudson. 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 at any time. 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 Thea Hudson, its Board Members, staff, and all relevant employees 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 ths document and I wish to participate in fitness activities.

Signature / Parent or Guardian *

Marketing and Data Agreement

I hereby agree to be contacted by Thea Hudson fitness for marketing and newsletters. We will never pass your Data onto a 3rd party.

Privacy policy available here: https://tinyurl.com/yaehyaq5

Signature*