contact@j-active.co.uk
01548 550372
Home
Fitness Centre
PAR-Q FORM
Calorie Requirements Form
Personal Training
Personal Training Questionnaire
Classes & Services
Plans & Packages
J-Active TV
J-Active TV - Member Zone
SHOP
Gift Card
Landing Page
Fit Blog
Programme
Follow Us:
Join J-Active Community Group:
Log In
PAR - Q form
To take part in J-Active Classes, Personal Training Sessions or Private Gym session please complete a PAR - Q form prior your first session.
First Name
Last Name
Email Address
Name & Surname of Emergency Contact
Phone Number
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
No
Yes
Have you ever felt pain in your chest when you were doing physical activity?
No
Yes
In the past month, have you had chest pain when you were not doing physical activity?
No
Yes
Do you often feel faint, have spells or severe dizziness or have lost consciousness?
No
Yes
Have you ever suffered from unusual shortness of breath at rest or with mild exertion?
No
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?
No
Yes
Do you have either high or low blood pressure? If yes, which type?
No
Yes
Are you currently on any prescribed medicines that may affect your ability to exercise?
No
Yes
Are you pregnant or have you had a baby in the last 6 months?
No
Yes
Do you know of any other reason that would affect your ability to participate in physical activity?
No
Yes
If you answered YES to one or more questions: Please provide details below.
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.
I will not attend the session if I feel unwell. I have read & understood the Cancellation Policy.
I wish to be informed about upcoming events and agree for my email to be added to J-Active 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.
Name & Surname
Your Signature
Clear
Today's Date
Submit PAR-Q Form
Thank you for submitting the form!
