Set Up Form Par-Q 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 significantly change your physical activity pattern. If you are over 69 years of age and are not used to being very active, check with your doctor before you partake in any exercise.PLEASE FILL IN THE BELOW: Full name:(required) Date of birth: Emergency contact name:(required) Emergency contact number:(required) Surgery name:(required) Doctor's name:(required) Please read carefully and answer each question honestly, answering yes or no where appropriate. 1. Has your doctor told you that you have a heart condition and that you should only perform physical activity recommended by a doctor?(required) 2. Do you feel pain in your chest when performing physical activity?(required) 3. Have you experienced chest pain when NOT performing physical activity in the last month?(required) 4. Do you lose your balance because of dizziness or have you lost consciousness recently?(required) 5. Do you have any bone or joint problems such as arthritis which could be aggravated through physical activity?(required) 6. Is your doctor currently prescribing you medications for high blood pressure or a heart condition?(required) 7. Have you had an operation in the last 12 months?(required) 8. Is there any reason why you should NOT participate in physical activity?(required) If you answered YES to the final question, please give your reason(s) below: If you answered Yes: If you answered yes to one or more questions, are older than age 40 and have been inactive or are concerned about your health please consult a physician before substantially increasing your physical activity. You should ask for medical clearance along with information about specific exercise limitations you may have. In most cases you will still be able to take part in physical activity as long as you adhere to guidelines. If you answered No: If you answered no to all the questions above you can be reasonably sure that you can exercise safely and have a low risk of having any medical complications from exercise. It is still important to start exercising slowly and increase intensity gradually. It may also be helpful to have a fitness assessment with a fitness instructor or personal trainer in order to determine where to begin. *Please note*: If your health changes so that subsequently you answer YES to any of the above questions, please inform your fitness or health professional immediately and ask whether you should change your physical activity or exercise plan. If you answered NO to all of the above, please continue and fill in the below: Informed Consent Please read the below in full and fill out the fields to give your consent. The purpose of an exercise programme is to help you achieve your health and fitness goals. Your programme will be based upon your current fitness levels and the goals that you wish to achieve. You may experience feelings of exertion, an increased temperature, and elevated heart rate during your sessions. As your fitness improves, you should be able to participate in more vigorous levels of activity, but this will remain within your capabilities. All exercises will be explained and demonstrated to you, but please feel free to ask questions before, during, or after a session. Any exercise programme carries with it an element of risk. Your sessions are designed to minimise risks, whilst providing an effective programme. Please inform your trainer if, for any reason, you should not participate in an activity. (An example may be illness or injury, which might be aggravated by exercise.) During the sessions with your trainer, you will be closely supervised. If at any time you feel undue pain or excessive discomfort, stop the activity and inform the trainer of your symptoms. You are free to withdraw from any activity at any time you wish. Declaration I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise and my participation may involve a risk of injury. I understand and confirm that: *The nature, purpose, risks and benefits of exercise have been explained to me. I understand what is required of me and that I may withdraw at any time. *I have read, understood and completed the questionnaire. *I agree to take part in the programme described to me by my trainer. *I give my consent for images and videos to be taken for the purposes of social media and website use. Your full name:(required) Today's date:(required) Trainer’s name: Kelly Hayes *Please note*: This physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if your condition changes, which may mean that you would answer YES to any of the questions above. If your condition does change, please inform your trainer. Submit Δ Share this:TwitterFacebookLike this:Like Loading...
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