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Physical Activity Readiness Questionnaire (PAR-Q)

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of 15 and 69, the PAR-Q will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly; check YES or NO.

The purpose of this form is to protect your health and safety. Please read this form before you attend your first class in order to discover whether there is any reason why exercise may not be safe for you. If you are in any doubt, email info@collesso.co.uk

Depending on your answers to these questions, it may be unsafe for you to exercise, and you may be asked to withdraw. We may also suggest that you see a health professional to determine whether exercise is safe for you.

Your answers will be stored and used in line with the GDPR and Data Protection Act 2018 and will not be shared with any other parties. The information you provide will be kept in confidence. At any

future classes, for your own safety you will be regularly asked whether your answers to any of these questions have changed.

  1. Personal Details / Child Details(if completing form as a parent/guardian)

Date of Birth
Month
Day
Year

For under 18's the below section is to be filled out by a parent or guardian,

including:

- Contact details in case of emergency

- Medical questions

  1. Emergency Contact Details

  1. Medical Questions (PAR-Q)

Has your doctor ever said that you have a heart condition and that you should only 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 or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
Yes
No
Do you know of any other reason why you should not do physical activity?
Yes
No

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q (this form) and which questions you answered YES.

You may be able to do any activity you want as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow their advice.

  1. Photos

If clients are agreeable, we often post class photos on social media (Facebook and Instagram) and sometimes on the website. Are you UNcomfortable with having photos of you/your child posted on social media?
Yes
No

  1. Your Signature/Signature as a parent or guardian

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