Informed consent form Physical Activity Readiness Questionnaire and Consent Form Taking part in exercise is generally safe for most people, However, some people are advised to check with their doctor before taking part in an exercise session. This PARq will help you to check if you should consult your doctor before beginning the exercise programme. Please answer the questions honestly, taking time to consider each question. Your Contact Details Full Name* Email* Telephone Number* Mobile Number* Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year Address* Street Address Street Address Line 2 City PostcodeYour Emergency Contact Details Full Name of Emergency Contact* Telephone Number of Emergency Contact* Mobile Number of Emergency Contact* Address of Emergency Contact* Street Address Street Address Line 2 City PostcodePhysical Activity Readiness QuestionnaireIf you answer 'YES' to any of the questions below you must have your doctor's consent before you take part in any physical activity on this training. You will be required to provide a doctor's consent letter, which you must provide to us via upload link below 1. Has your doctor ever said that you have a heart condition and recommended only medially supervised activity?*YesNo 2. Do you have chest pain brought on by physical activity?*YesNo 3. Have you developed chest pain in the last month?*YesNo 4. Do you tend to lose consciousness or fall over as a result of dizziness?*YesNo 5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*YesNo 6. Do you suffer from asthma, diabetes, high blood pressure, epilepsy or heart condition?*YesNo If you answered yes to question 6. please specify 7. Do you have any current conditions or injuries that are being treated by a doctor, physiotherapist or health professional?*YesNo If you answered yes to question 7. please specify 8. Do you know of any other reason why you should not take part in exercise?*YesNo If you answered 'YES' to any of these questions please provide your doctor's consent letter. Allowed files to upload: jpg, jpeg, png, pdf, txt, doc, docx, Please tick to consent your signature*YesNo reCAPTCHA I consent collecting this data and processing it according to Easyactive8 Privacy Policy of this website.SubmitReset
