PAR - Q form

To take part in our Classes, please complete a PAR - Q form prior your first session.

First Name

Email Address

Last Name

Date of Birth

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

Yes

Have you ever felt pain in your chest when you were doing physical activity?

Yes

In the past month, have you had chest pain when you were not doing physical activity?

Yes

Do you often feel faint, have spells or severe dizziness or have lost consciousness?

Yes

Have you ever suffered from unusual shortness of breath at rest or with mild exertion?

Yes

Has the doctor ever said that you have a bone or joint problem, such as arthritis, that has been aggraveted by exercise or that may be worse by exercise?

Yes

Do you have either high or low blood pressure? If yes, which type?

Yes

Are you currently on any prescribed medicines that may affect your ability to exercise?

Yes

Are you pregnant or have you had a baby in the last 6 months?

Yes

Do you know of any other reason that would affect your ability to participate in physical activity?

Yes

If you answered YES to one or more questions: Please provide details below.

Are you joining one classes at J-Active Fitness Centre?

Yes

If you answered YES to one or more questions: Talk to your doctor either in person or by phone before you start becoming more physically active and/or taking a fitness appraisal. Tell your doctor what questions you answered yes to on this form. You may still be able to do any activity you want as long as you start slowly and build up gradually or it may be that you need to restrict your activities to those which are safe for you.

I understand that my participation in exercise programmes, classes or events and any related activity conducted by J-Active trainers, is voluntary and at my own risk. I am aware that exercise can be physically stressful and, in certain instances, can even result in injury or cause death. The levels of exercise thatI will perform will be at my own pace, based upon my cardio-respiratory (heart & lung) fitness, muscular strength and endurance. I hereby state that I will inform the trainer of any symptoms (e.g. fatigue, shortness of breath, chest discomfort, any pain/discomfort/concern for my safety/benefit) during my participation in exercise. Understand that I will be given instructions on how to perform an exercise and use equipment and I will ask the trainer any questions if I do not understand.

Wish to be informed about all upcoming Events and agree for my email to be added to J-Active Newsletter List. I agree that if any videos or pictures taked during the training session, may be used for marketing purposes such as Social Media, Email Marketing and understand that I have rights to change my preferences any time.

I have read understood and agree to follow all Covid-19 guideliness & rules during the sessions.

Name & Surname

Today's Date

Your Signature

Thank you for submitting the form!

contact@j-active.co.uk

01548 550372

PAR - Q form

contact@j-active.co.uk

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